Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Preoperative prostate health index predicts poor pathologic outcomes of radical prostatectomy in patients with biopsy-detected low-risk patients prostate cancer: results from a Chinese prospective cohort

Abstract

Objective

To determine the performance of the prostate health index (PHI) in predicting pathologic outcomes of radical prostatectomy (RP) in Chinese patients with low-risk prostate cancer (PCa).

Methods

Of all consecutive patients who underwent RP in one tertiary center from September 2013 to January 2017, we prospectively examined the data of 140 patients with low-risk PCa based on the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. All patients were eligible for active surveillance, but underwent RP. Clinical and pathological data were collected. Logistic regression was used to evaluate the associations between the PHI and outcome of RP. The area under the receiver operating curve (AUC) was used to evaluate the accuracy of different models. Decision curve analysis was used to evaluate the potential clinical usefulness of making model-based decisions.

Results

Only 44 (31.4%) patients were finally confirmed to have organ-confined Gleason ≤6 PCa. A low PHI was significantly predictive of organ-confined Gleason ≤6 PCa (p = 0.001), while tPSA and f/tPSA were not associated with final pathology. In the multivariate analyses, addition of the PHI significantly increased the predictive accuracy (AUC = 0.767, 95% Cl 0.685–0.849, p < 0.001).

Conclusion

The PRIAS criteria for active surveillance may not suitable for Chinese patients with PCa. Addition of the PHI to the PRIAS models improved the prognostic performance. If confirmed in future larger and multicenter studies, PHI may help us to identify patients eligible for AS in China.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Hugosson J, Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P, et al. Mortality results from the Goteborg randomised population-based prostate-cancer screening trial. Lancet Oncol. 2010;11(8):725–32.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, et al. Overdiagnosis and overtreatment of prostate cancer. Eur Urol. 2014;65(6):1046–55.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mikolajczyk SD, Millar LS, Wang TJ, Rittenhouse HG, Marks LS, Song W, et al. A precursor form of prostate-specific antigen is more highly elevated in prostate cancer compared with benign transition zone prostate tissue. Cancer Res. 2000;60(3):756–59.

    CAS  PubMed  Google Scholar 

  4. Lazzeri M, Haese A, de la Taille A, Palou Redorta J, McNicholas T, Lughezzani G, et al. Serum isoform [-2]proPSA derivatives significantly improve prediction of prostate cancer at initial biopsy in a total PSA range of 2-10 ng/ml: a multicentric European study. Eur Urol. 2013;63(6):986–94.

    Article  CAS  PubMed  Google Scholar 

  5. Huang YQ, Sun T, Zhong WD, Wu CL. Clinical performance of serum [-2]proPSA derivatives, %p2PSA and PHI, in the detection and management of prostate cancer. Am J Clin Exp Urol. 2014;2(4):343–50.

    PubMed  PubMed Central  Google Scholar 

  6. Guazzoni G, Lazzeri M, Nava L, Lughezzani G, Larcher A, Scattoni V, et al. Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer. Eur Urol. 2012;61(3):455–66.

    Article  CAS  PubMed  Google Scholar 

  7. Fossati N, Buffi NM, Haese A, Stephan C, Larcher A, McNicholas T, et al. Preoperative Prostate-specific Antigen Isoform p2PSA and Its Derivatives, %p2PSA and Prostate Health Index, Predict Pathologic Outcomes in Patients Undergoing Radical Prostatectomy for Prostate Cancer: Results from a Multicentric European Prospective Study. Eur Urol. 2015;68(1):132–38.

    Article  CAS  PubMed  Google Scholar 

  8. Chiu PK, Lai FM, Teoh JY, Lee WM, Yee CH, Chan ES, et al. Prostate health index and %p2PSA predict aggressive prostate cancer pathology in Chinese patients undergoing radical prostatectomy. Ann Surg Oncol. 2016;23(8):2707–14.

    Article  PubMed  Google Scholar 

  9. Godtman RA, Holmberg E, Khatami A, Stranne J, Hugosson J. Outcome following active surveillance of men with screen-detected prostate cancer. Results from the Goteborg randomised population-based prostate cancer screening trial. Eur Urol. 2013;63(1):101–07.

    Article  PubMed  Google Scholar 

  10. Louie-Johnsun M, Neill M, Treurnicht K, Jarmulowicz M, Eden C. Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically. BJU Int. 2009;104(10):1501–04.

    Article  PubMed  Google Scholar 

  11. Mufarrij P, Sankin A, Godoy G, Lepor H. Pathologic outcomes of candidates for active surveillance undergoing radical prostatectomy. Urology. 2010;76(3):689–92.

    Article  PubMed  Google Scholar 

  12. van den Bergh RC, Roemeling S, Roobol MJ, Aus G, Hugosson J, Rannikko AS, et al. Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Eur Urol. 2009;55(1):1–8.

    Article  PubMed  Google Scholar 

  13. Iremashvili V, Pelaez L, Manoharan M, Jorda M, Rosenberg DL, Soloway MS. Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol. 2012;62(3):462–68.

    Article  PubMed  Google Scholar 

  14. Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R, et al. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst. 2009;101(6):374–83.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Draisma G, Boer R, Otto SJ, van der Cruijsen IW, Damhuis RA, Schroder FH, et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European randomized study of screening for prostate cancer. J Natl Cancer Inst. 2003;95(12):868–78.

    Article  PubMed  Google Scholar 

  16. McVey GP, McPhail S, Fowler S, McIntosh G, Gillatt D, Parker CC. Initial management of low-risk localized prostate cancer in the UK: analysis of the British Association of urological surgeons cancer registry. BJU Int. 2010;106(8):1161–64.

    Article  PubMed  Google Scholar 

  17. Zhu Y, Wang HK, Qu YY, Ye DW. Prostate cancer in East Asia: evolving trend over the last decade. Asian J Androl. 2015;17(1):48–57.

    Article  PubMed  Google Scholar 

  18. Yamada Y, Sakamoto S, Sazuka T, Goto Y, Kawamura K, Imamoto T, et al. Validation of active surveillance criteria for pathologically insignificant prostate cancer in Asian men. Int J Urol. 2016;23(1):49–54.

    Article  PubMed  Google Scholar 

  19. Lim SK, Kim KH, Shin TY, Chung BH, Hong SJ, Choi YD, et al. Yonsei criteria: a new protocol for active surveillance in the era of robotic and local ablative surgeries. Clin Genitourin Cancer. 2013;11(4):501–07.

    Article  PubMed  Google Scholar 

  20. El Hajj A, Ploussard G, de la Taille A, Allory Y, Vordos D, Hoznek A, et al. Analysis of outcomes after radical prostatectomy in patients eligible for active surveillance (PRIAS). BJU Int. 2013;111(1):53–59.

    Article  CAS  PubMed  Google Scholar 

  21. Na R, Ye D, Liu F, Chen H, Qi J, Wu Y, et al. Performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and the prostate health index (PHI) in a Chinese hospital-based biopsy population. Prostate. 2014;74(15):1569–75.

    Article  CAS  PubMed  Google Scholar 

  22. Porpiglia F, Cantiello F, De Luca S, Manfredi M, Veltri A, Russo F, et al. In-parallel comparative evaluation between multiparametric magnetic resonance imaging, prostate cancer antigen 3 and the prostate health index in predicting pathologically confirmed significant prostate cancer in men eligible for active surveillance. BJU Int. 2016;118(4):527–34.

    Article  PubMed  Google Scholar 

  23. Cantiello F, Russo GI, Cicione A, Ferro M, Cimino S, Favilla V, et al. PHI and PCA3 improve the prognostic performance of PRIAS and Epstein criteria in predicting insignificant prostate cancer in men eligible for active surveillance. World J Urol. 2016;34(4):485–93.

    Article  PubMed  Google Scholar 

  24. Tosoian JJ, Loeb S, Feng Z, Isharwal S, Landis P, Elliot DJ, et al. Association of [-2]proPSA with biopsy reclassification during active surveillance for prostate cancer. J Urol. 2012;188(4):1131–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hirama H, Sugimoto M, Ito K, Shiraishi T, Kakehi Y. The impact of baseline [-2]proPSA-related indices on the prediction of pathological reclassification at 1 year during active surveillance for low-risk prostate cancer: the Japanese multicenter study cohort. J Cancer Res Clin Oncol. 2014;140(2):257–63.

    Article  PubMed  Google Scholar 

  26. Link RE, Shariat SF, Nguyen CV, Farr A, Weinberg AD, Morton RA, et al. Variation in prostate specific antigen results from 2 different assay platforms: clinical impact on 2304 patients undergoing prostate cancer screening. J Urol. 2004;171(6 Pt 1):2234–38.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by National Natural Science Foundation of China (Grant No. 81672544 and No. 81502192) and Shanghai Rising Star Program (Grant No. 16QA1401100).

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Yao Zhu or Ding-Wei Ye.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Additional information

Bo Tang, and Cheng-Tao Han contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tang, B., Han, CT., Lu, XL. et al. Preoperative prostate health index predicts poor pathologic outcomes of radical prostatectomy in patients with biopsy-detected low-risk patients prostate cancer: results from a Chinese prospective cohort. Prostate Cancer Prostatic Dis 21, 64–70 (2018). https://doi.org/10.1038/s41391-017-0002-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-017-0002-0

This article is cited by

Search

Quick links