Prostate Health Index Shown to Decrease Number of Prostate Biopsies

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Results of a large prospective study show that appropriate use of the phi test can improve physicians' ability to diagnose and manage patients.
Results of a large prospective study show that appropriate use of the phi test can improve physicians' ability to diagnose and manage patients.

Appropriate use of Prostate Health Index (phi) testing can reduce the number of prostate biopsies performed as part of a diagnostic workup for prostate cancer (PCa), according to a new study.

At each of 4 large urology group practices, men receiving a phi test were compared with a historical control group of men who were eligible for a phi test but did not receive it and were seen by the same participating urologists prior to implementation of the phi test in their practice. Inclusion criteria included age 50 years or older, total serum PSA level of 4–10 ng/mL, and non-suspicious DRE findings.

The study, by Jay White, MPH, PhD, of Carolina Urology Partners in Huntersville, North Carolina, and colleagues, included a total of 506 men who received a phi test and 683 controls. According to the investigators, their study is the largest prospective investigation to date examining the clinical utility of phi testing for men undergoing diagnostic assessment for PCa.

Results showed a significant reduction in the proportion of phi recipients who underwent a prostate biopsy compared with controls (36.4% vs 60.3%), the investigators reported online ahead of print in Prostate Cancer and Prostatic Diseases. In addition, based on questionnaire responses from physicians, the phi score impacted physicians' patient management plan in 73% of cases, including biopsy deferrals when the phi score was low, and decisions to perform biopsies when the phi score indicated an intermediate or high probability of PCa (phi 36 or higher).

Although the proportion of positive biopsy findings did not increase in the prospective group, the investigators reported a modest decrease in the overall percentage of low-grade Gleason 6 tumors detected compared with the control group (9.9% vs 18.4%, respectively).

“Our results show that appropriate utilization of phi can significantly modify physician behavior patterns and improve their ability to diagnose and manage their patients,” Dr White's group concluded. “We believe our study supports the routine use of phi testing for men presenting with elevated serum total PSA and non-suspicious DRE findings.”

Reference

White J, Shenoy BV, Tutrone RF, et al. Clinical utility of the Prostate Health Index (phi) for biopsy decision management in a large group urology practice setting. Prostate Cancer Prostatic Dis. 2017; published online ahead of print.

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