Article

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

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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.

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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

Author notes

    Affiliations

    1. Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong’an Road, Shanghai, 200032, China

      • Bo Tang
      • , Cheng-Tao Han
      • , Xiao-Lin Lu
      • , Fang-Ning Wan
      • , Cui-Zhu Zhang
      • , Yao Zhu
      •  & Ding-Wei Ye
    2. Department of Oncology, Shanghai Medical Colleague, Fudan University, Shanghai, 200032, China

      • Bo Tang
      • , Cheng-Tao Han
      • , Xiao-Lin Lu
      • , Fang-Ning Wan
      • , Cui-Zhu Zhang
      • , Yao Zhu
      •  & Ding-Wei Ye

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    Conflict of interest

    The authors declare that they have no competing interest.

    Corresponding authors

    Correspondence to Yao Zhu or Ding-Wei Ye.