Impact of Prostate Health Index Results for Prediction of Biopsy Grade Reclassification during Active Surveillance

Christopher P. Filson, Kehao Zhu, Yijian Huang, Yingye Zheng, Lisa F. Newcomb, Sierra Williams, James D. Brooks, Peter R. Carroll, Atreya Dash, William J. Ellis, Martin E. Gleave, Michael A. Liss, Frances Martin, Jesse K. McKenney, Todd M. Morgan, Andrew A. Wagner, Lori J. Sokoll, Martin G. Sanda, Daniel W. Chan, Daniel W. Lin

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: We assessed whether Prostate Health Index results improve prediction of grade reclassification for men on active surveillance. Methods and Materials: We identified men in Canary Prostate Active Surveillance Study with Grade Group 1 cancer. Outcome was grade reclassification to Grade Group 2D cancer. We considered decision rules to maximize specificity with sensitivity set at 95%. We derived rules based on clinical data (R1) vs clinical dataDProstate 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. Results: 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 Dsensitivity [ –4% and Dspecificity [ D6%. There was slight improvement for R3 vs R1 for confirmatory biopsy (AUC 0.745 vs R1 0.724, DAUC 0.021, 95% CI 0.002-0.041) but not for subsequent biopsies (DAUC –0.012, 95% CI –0.031-0.006). R3 did not have better discrimination vs R1 among the biopsy cohort overall (DAUC 0.007, 95% CI –0.007-0.020). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1037-1045
Number of pages9
JournalJournal of Urology
Volume208
Issue number5
DOIs
StatePublished - Nov 1 2022

Keywords

  • biomarkers
  • prostatic neoplasms
  • watchful waiting

ASJC Scopus subject areas

  • Urology

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