Prostate Health Index Improves Biopsy Decisions in Men with Elevated PSA

What is it about?

The study evaluates the impact of the Prostate Health Index (PHI) on clinical decisions for men with PSA levels between 4 and 10 ng/mL and normal digital rectal exams in Hong Kong's public hospitals. Conducted from May 2016 to August 2017, it involved 2828 patients who were followed up for 2 years. Results showed that 83% of men with elevated PSA levels chose not to undergo biopsy after PHI testing. The PHI score effectively guided biopsy decisions, with higher scores correlating with increased detection of high-grade prostate cancer. The PHI was found to improve the detection rate of significant prostate cancers and help tailor biopsy decisions and follow-up frequency.

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Why is it important?

This research is significant because it evaluates the impact of the Prostate Health Index (PHI) on clinical decision-making for men with elevated PSA levels in a real-life setting. Understanding how PHI influences biopsy decisions is crucial for improving prostate cancer screening and reducing unnecessary biopsies. The study's findings contribute to the growing body of evidence supporting the use of PHI as a tool to individualize biopsy decisions and optimize follow-up strategies. This research has the potential to improve patient care by reducing overdiagnosis and overtreatment of indolent prostate cancer while still effectively identifying high-risk cases. Key Takeaways: 1. Biopsy Reduction: Incorporating PHI into the clinical pathway resulted in 83% of patients with elevated PSA levels deciding not to undergo initial prostate biopsy, potentially reducing unnecessary procedures and associated risks. 2. Improved Detection: The study demonstrated that PHI improved the detection rate of high-grade prostate cancer compared to PSA-driven strategies, with higher initial detection rates of ISUP Grade Group ≥2 cancer in the PHI score ≥35 group. 3. Predictive Value: Higher baseline PHI scores were found to be significant predictors of subsequent biopsy outcomes at 2 years, suggesting that PHI can be used to guide the frequency of follow-up visits and long-term management strategies for patients with elevated PSA levels.