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PHI and PCA3 improve the prognostic performance of PRIAS and Epstein criteria in predicting insignificant prostate cancer in men eligible for active surveillance

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Abstract

Purpose

To assess the performance of prostate health index (PHI) and prostate cancer antigen 3 (PCA3) when added to the PRIAS or Epstein criteria in predicting the presence of pathologically insignificant prostate cancer (IPCa) in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS).

Methods

An observational retrospective study was performed in 188 PCa patients treated with laparoscopic or robot-assisted RP but eligible for AS according to Epstein or PRIAS criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements. Multivariate logistic regression analyses and decision curve analysis were carried out to identify predictors of IPCa using the updated ERSPC definition.

Results

At the multivariate analyses, the inclusion of both PCA3 and PHI significantly increased the accuracy of the Epstein multivariate model in predicting IPCa with an increase of 17 % (AUC = 0.77) and of 32 % (AUC = 0.92), respectively. The inclusion of both PCA3 and PHI also increased the predictive accuracy of the PRIAS multivariate model with an increase of 29 % (AUC = 0.87) and of 39 % (AUC = 0.97), respectively. DCA revealed that the multivariable models with the addition of PHI or PCA3 showed a greater net benefit and performed better than the reference models. In a direct comparison, PHI outperformed PCA3 performance resulting in higher net benefit.

Conclusions

In a same cohort of patients eligible for AS, the addition of PHI and PCA3 to Epstein or PRIAS models improved their prognostic performance. PHI resulted in greater net benefit in predicting IPCa compared to PCA3.

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Acknowledgments

Nothing to declare.

Author contributions

Protocol/project development: Cantiello F, Russo GI, Cicione A, Ferro M. Data collection or management: Cantiello F, Russo GI, Ferro M, Perdonà S, Favilla V, Cimino S. Data analysis: Cantiello F, Russo GI, Cicione A. Manuscript writing/editing: Cantiello F, Russo GI. Supervision: De Cobelli O, Magno C, Morgia G, Damiano R.

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Correspondence to Francesco Cantiello.

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Each author declares no conflict of interest.

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Francesco Cantiello and Giorgio Ivan Russo have contributed equally to this manuscript.

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Cantiello, F., Russo, G.I., Cicione, A. et al. PHI and PCA3 improve the prognostic performance of PRIAS and Epstein criteria in predicting insignificant prostate cancer in men eligible for active surveillance. World J Urol 34, 485–493 (2016). https://doi.org/10.1007/s00345-015-1643-z

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  • DOI: https://doi.org/10.1007/s00345-015-1643-z

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