Clinical relevance and appropriateness of PHI (Prostate Health Index). Our experience.
PHI (Prostate Health Index) is a new parameter for evaluation of prostatic cancer risk.
It consists of a mathematical elaboration of total serum PSA, Free PSA and (-2) pro PSA values.
[-2]proPSA is the most specific and stabile isoform of PSA, detected in prostate cancer tissues.
PHI value derives from the elaboration of this formula: phi = [-2] proPSA / f PSA * √ t PSA.
PHI allows us to classify Patients in low, mean and high risk for cancer.
The right administration of this exam is in men over 50 years old with total PSA between 2 and 10ng/ml with negative DRE.
Methods and results
122 Patients underwent PHI test from October 2011 to April 2012. We analyze results, appropriateness and clinical relevance of the test.
The request of examination is found to be correct for the range of PSA in 99 (81%) and for the age group in 119 (97%) cases. 39 patients (39.4%) allocated to PSA and age reported F / T PSA ratio above 18%.
In the group of patients in which they were observed the right recommendations and with a ratio of PSA less than 18%, 10 patients (25.6%) resulted in a high risk, 28 (71.8%) in a medium risk and 1 (2, 6%) in a class of low risk.
4 of 10 Patients at high risk underwent a sestant prostatic biopsy(>12 specimen). 1 Patient resulted in prostatic cancer, 1 Patient had HG PIN and in 2 Patients cancer was not found.
4 Patients at mean or low risk underwent a sestant prostatic biopsy (>12 specimen) with negative results for cancer.
PHI is a new tool for early diagnosis of prostatic cancer, but, only if properly administred, it can show its real reliability.
For example PHI should help the urologist to obtain an important reduction of negative prostate biopsies and to avoid the prostate cancer overtreatment.
Another important target of the PHI test is the improvement of the early diagnosis and consequently the early treatment of aggressive prostatic neoplasms due to [-2] pro PSA isoform specific expression in prostate cancer tissues.
Only a correct DRE, Total PSA, Free PSA and Free/Total Ratio can reduce number of inappropriate PHI test and its economic impact.
Lazzeri M, Haese A, de la Taille A, Palou Redorta J, McNicholas T, Lughezzani G, Scattoni V, Bini V, Freschi M, Sussman A, Ghaleh B, Le Corvoisier P, Alberola Bou J, Esquena Fernández S, Graefen M, Guazzoni G. Serum Isoform [-2]proPSA Derivatives Significantly Improve Prediction of Prostate Cancer at Initial Biopsy in a Total PSA Range of 2-10 ng/ml: A Multicentric European Study. Eur Urol. 2013