Korean J Urol Oncol.  2020 Aug;18(2):147-154. 10.22465/kjuo.2020.18.2.147.

Potential Utility of Prostate Health Index Density for Prostate Cancer Detection and Prediction in Korean Men: A Prospective Multicenter Study

  • 1Department of Urology, Kangwon National University School of Medicine, Chuncheon, Korea
  • 2Department of Urology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 3Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea


We evaluated the clinical performance of Prostate Health Index (PHI) density with [-2]proPSA (p2PSA)and its derivatives in predicting the presence of prostate cancer (PCa) in Korean men.
Materials and Methods
A total of 706 men with total prostate-specific antigen (tPSA)≥2.5 ng/mL who underwenttheir first prostate biopsy were included in this prospective, multicenter, observational study. Diagnostic accuracyof tPSA, free-to-total PSA ratio (%fPSA), p2PSA, %p2PSA, the Beckman Coulter PHI, and PHI density wasassessed by receiver operating characteristic curve analyses and logistic regression analyses. PHI was calculatedas [(p2PSA/free PSA)×tPSA½], and density calculations were performed using prostate volume as determinedby transrectal ultrasonography.
Overall, PCa was detected in 367 of all subjects (52%). In men with tPSA 2.5–10 ng/mL, the detectionrate of PCa was 41.1% (188 of 457). In this group, PHI and PHI density were the most accurate predictorsof PCa and significantly outperformed tPSA and %fPSA; area under the curve for tPSA, %fPSA, %p2PSA, PHI,and PHI density was 0.58, 0.68, 0.70, 0.75, 0.73 respectively. PHI and PHI density were also the strongestpredictor of PCa with Gleason score ≥7.
Based on the present prospective multicenter experience, PHI and PHI density demonstrate thesuperior clinical performance in predicting the presence of PCa in Korean men with tPSA 2.5–10 ng/mL.


Biomarkers; Biopsy; Early diagnosis; Prostatic cancer; Prostate-specific antigen; Protein isoforms
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