Prostate cancer: PHI density testing could avoid 38% of unnecessary biopsies

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  • Prostate health index (PHI) density more accurately detected clinically-significant prostate cancer (PCa) than percentage free PSA (%fPSA), PHI, PSA density (PSAD), and the product of %fPSA and prostate volume (%fPSA*volume).

Why this matters

  • PHI density is a relatively simple measure.

Key results

  • On biopsy, 47 (39.8%) had clinically-significant PCa. 
  • Men with clinically-significant PCa were more frequently African-American (P=.045), had lower %fPSA and prostate volume, and higher PHI, PSAD, and PHI density (all P<.001). 
  • At a threshold of 0.43, PHI density had sensitivity of 97.9% and specificity of 38.0% for detection of significant disease. 
  • PHI density <0.43 had negative predictive value of 96.4%. 
  • PHI density >0.43 conferred 100% sensitivity for Gleason score ≥7 disease. 
  • Prevalence of clinically-significant PCa increased from 3.6% in men with PHI density <0.43, to 36.7% with PHI density 0.43-1.21, and 80.0% with PHI density >1.21 (P<.001). 
  • PHI density demonstrated the highest discriminative ability for clinically-significant disease (AUC, 0.84) compared with PSAD (AUC, 0.70), %fPSA (AUC, 0.75), %fPSA*volume (AUC, 0.79), and PHI (AUC, 0.76).

Study design

  • Prospective study of 118 patients undergoing biopsy within 6 mo of testing. 
  • Funding: None specified.


  • Single-center experience. 
  • Small cohort.