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Prostate Health Index and %p2PSA Predict Aggressive Prostate Cancer Pathology in Chinese Patients Undergoing Radical Prostatectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the performance of prostate health index (PHI) and percentage prostate-specific antigen (PSA) isoform [−2]proPSA (%p2PSA) in predicting pathologic outcomes at radical prostatectomy (RP) in a Chinese population.

Methods

We performed a prospective study of 135 prostate cancer patients with RP. The accuracy of preoperative %p2PSA (= p2PSA/free PSA) and PHI [= (p2PSA/free PSA) × √PSA] in predicting pathologic outcomes of RP including pT3 disease, pathologic Gleason score (pGS) ≥7, Gleason score (GS) upgrade at RP, tumor volume >0.5 ml, and Epstein criteria for significant tumor were calculated using multivariate analyses and area under the curve. The base model in multivariate analysis included age, PSA, abnormal digital rectal examination, and biopsy GS.

Results

PHI was significantly higher in patients with pT3 or pGS ≥ 7 (p < 0.001), pT3 disease (p = 0.001), pGS ≥ 7 (p < 0.001), GS upgrade (p < 0.001), tumor volume >0.5 ml (p < 0.001), and Epstein criteria for significant tumor (p = 0.001). %p2PSA was also significantly higher in all the above outcomes. The risk of pT3 or pGS ≥ 7 was 16.1 % for PHI < 35 and 60.8 % for PHI > 35 (sensitivity 84.2 %, specificity of 60.3 %), and the risk of tumor volume >0.5 ml was 25.5 % for PHI < 35 and 72.6 % for PHI > 35 (sensitivity 79.1 %, specificity 67.2 %). In multivariate analysis, adding %p2PSA or PHI to the base model significantly improved the accuracy (area under the curve) in predicting pT3 or pGS ≥ 7 (by 7.2–7.9 %), tumor volume >0.5 ml (by 10.3–12.8 %), and Epstein criteria for significant tumor (by 13.9–15.9 %). Net clinical benefit was observed in decision curve analyses for prediction of both tumor volume >0.5 ml, and pT3 or pGS ≥ 7.

Conclusions

Both PHI and %p2PSA predict aggressive and significant pathologies in RP in Chinese men. This enabled identification of nonaggressive cancers for better counseling on active surveillance or treatment.

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Acknowledgment

The instruments and testing reagents for the study were provided free of charge by Beckman Coulter, with no restriction or involvement on study planning, study results, or their presentation.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Peter Ka-Fung Chiu MBChB, FRCSEd (Urol), FHKAM (Surg), Jeremy Yuen-Chun Teoh MBBS, MRCSEd, Wai-Man Lee Msc, Chi-Hang Yee MBBS, FRCSEd (Urol), FHKAM (Surg), Eddie Shu-Yin Chan MD, MBChB, FRCSEd (Urol), FHKAM (Surg), See-Ming Hou MBBS, FRCSEd (Urol), FHKAM (Surg) & Chi-Fai Ng MD, MBChB, FRCSEd (Urol), FHKAM (Surg)

  2. Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Fernand Mac-Moune Lai MD (Lyon), FRCPA, FHKCPath, MScFl (Leicester)

  3. S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Chi-Fai Ng MD, MBChB, FRCSEd (Urol), FHKAM (Surg)

Authors
  1. Peter Ka-Fung Chiu MBChB, FRCSEd (Urol), FHKAM (Surg)
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  2. Fernand Mac-Moune Lai MD (Lyon), FRCPA, FHKCPath, MScFl (Leicester)
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  3. Jeremy Yuen-Chun Teoh MBBS, MRCSEd
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  4. Wai-Man Lee Msc
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  5. Chi-Hang Yee MBBS, FRCSEd (Urol), FHKAM (Surg)
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  6. Eddie Shu-Yin Chan MD, MBChB, FRCSEd (Urol), FHKAM (Surg)
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  7. See-Ming Hou MBBS, FRCSEd (Urol), FHKAM (Surg)
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  8. Chi-Fai Ng MD, MBChB, FRCSEd (Urol), FHKAM (Surg)
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Corresponding author

Correspondence to Chi-Fai Ng MD, MBChB, FRCSEd (Urol), FHKAM (Surg).

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Chiu, P.KF., Lai, F.MM., Teoh, J.YC. et al. Prostate Health Index and %p2PSA Predict Aggressive Prostate Cancer Pathology in Chinese Patients Undergoing Radical Prostatectomy. Ann Surg Oncol 23, 2707–2714 (2016). https://doi.org/10.1245/s10434-016-5183-6

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  • DOI: https://doi.org/10.1245/s10434-016-5183-6

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