Can Prostate Health Index (PHI) help stratify patients with equivocal PI-RADS 3 lesions on prostate MRI to avoid MRI-Ultrasound fusion biopsies? –a two-centre real-world experience

Abstract

<p>Objective:We investigated the use ofProstate Health Index (PHI) as anadditional risk-stratification tool inpatients with equivocal PIRADS 3 lesions on multiparametric MRI(mpMRI) of the prostate.<br></p><p>Patients & Methods:All men withbiochemical or clinical suspicion ofhaving prostate cancer (PCa) whounderwent mpMRI of the prostate intwo tertiary centres between January2017 and June 2022 were included.Pre-biopsy PHI testing, followed byMRI/ultrasound fusion transrectal ortransperineal biopsies were performed.For those with PIRADS 3 lesions onlyon mpMRI, they were furtherstratified into four PHI risk-groups,and the cancer detection rates of PCaand clinically significant PCa (csPCa)were analysed accordingly.Results:Out of 747 patients included,353 (47.2%) patients had PIRADS 3lesions only on mpMRI, with meanserum PSA of 7.903.77 ng/mL.The overall PCa and csPCa detectionrates in this group were 28% (99/353)and 15% (53/353), respectively.Stratifying into the four PHI risk-groups, the cancer detection rates ofcsPCa had statistically significantdifferences: 5.7% in PHI<25, 8.0% inPHI 25–32, 11.5% in PHI 33–41 and34.4% in PHI>41 (p<0.01). With aPHI of<25, 25% (88/353) of thepatients who only had PIRADS 3lesions could have avoided a biopsy,at the expense of 5.7% risk of missingcsPCa.Conclusion:Ourfindings suggest thatPHI could be used as an additionalrisk stratification tool whencounselling patients with PIRADS 3lesions. Overdiagnosis andunnecessary biopsies could be avoidedin patients with very low PHI with asmall risk of missing csPCa.<br></p>