Abstact

We assessed whether Prostate Health Index results improve prediction of grade reclassification for men on active surveillance.

We identified men in Canary Prostate Active Surveillance Study with Grade Group 1 cancer. Outcome was grade reclassification to Grade Group 2+ cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R₁) vs clinical data+Prostate Health Index (R₃). We considered an "or"-logic rule combining clinical score and Prostate Health Index (R₄), and a "2-step" rule using clinical data followed by risk stratification based on Prostate Health Index (R₂). Rules were applied to a validation set, where values of R₂-R₄ vs R₁ for specificity and sensitivity were evaluated.

We included 1,532 biopsies (n = 610 discovery; n = 922 validation) among 1,142 men. Grade reclassification was seen in 27% of biopsies (23% discovery, 29% validation). Among the discovery set, at 95% sensitivity, R₂ yielded highest specificity at 27% vs 17% for R₁. In the validation set, R₃ had best performance vs R₁ with Δsensitivity = -4% and Δspecificity = +6%. There was slight improvement for R₃ vs R₁ for confirmatory biopsy (AUC 0.745 vs R₁ 0.724, ΔAUC 0.021, 95% CI 0.002-0.041) but not for subsequent biopsies (ΔAUC -0.012, 95% CI -0.031-0.006). R₃ did not have better discrimination vs R₁ among the biopsy cohort overall (ΔAUC 0.007, 95% CI -0.007-0.020).

Among active surveillance patients, using Prostate Health Index with clinical data modestly improved prediction of grade reclassification on confirmatory biopsy and did not improve prediction on subsequent biopsies.

Authors

• Brooks JD
• Carroll PR
• Chan DW
• Dash A
• Ellis WJ
• Filson CP
• Gleave ME
• Huang Y
• Lin DW
• Liss MA
• Martin F
• McKenney JK
• Morgan TM
• Newcomb LF
• Sanda MG
• Sokoll LJ
• Wagner AA
• Williams S
• Zheng Y
• Zhu K

PubMed ID

Appears In

J Urol, 2022, 208 (5)