The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men

Q: What is the main goal of using PHI and MRI prostate in this screening study?

To improve detection of clinically significant prostate cancer while reducing unnecessary biopsies compared with PSA-based screening alone.

Q: Who was included in the study population and how were participants selected?

Men aged 50–75 were recruited from a community-based PSA screening program, with PHI testing for PSA 4.0–10.0 ng ml−1 and MRI offered for PSA 4.0–50.0 ng ml−1.

Q: How were clinically significant prostate cancers defined?

Clinically significant prostate cancer was defined as ISUP grade group (GG) ≥2, or ISUP GG 1 with involvement of ≥30% of total systematic biopsy cores.

Sep 24, 2026

Uploaded by Anna Hans

Prostate cancer screening using PSA often causes overinvestigation and overdiagnosis of indolent disease. This study evaluates the added value of prostate health index (PHI) and MRI prostate within an Asian PSA screening program for Chinese men aged 50–75. Men with PSA 4.0–10.0 ng ml−1 underwent PHI testing; MRI was offered for PSA 4.0–50.0 ng ml−1. Biopsy decisions followed PHI thresholds and PSA levels, with targeted biopsy when PI-RADS ≥3. Additional MRI increased detection of clinically significant cancer, with the strongest benefit in PSA 4.0–9.9 and PHI ≥35.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Prostate cancer screening challenges

Role of PHI in risk stratification

Rationale for adding MRI prostate

Study background and prior evidence

Asian Journal of Andrology (2023) 25, 674–679 [www.asiaandro.com](www.asiaandro.com); [https://journals.lww.com/ajandrology](https://journals.lww.com/ajandrology) Open Access Prostate Cancer ORIGINAL ARTICLE The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men Peter KF Chiu1,*, Thomas YT Lam2,*, Chi-Fai Ng1, Jeremy YC Teoh1, Carmen CM Cho3, Hiu-Yee Hung3, Cindy Hong1, Monique J Roobol4, Winnie CW Chu3, Samuel YS Wong2, Joseph JY Sung5 Using prostate-specific antigen (PSA) for prostate cancer (PCa) screening led to overinvestigation and overdiagnosis of indolent PCa. We aimed to investigate the value of prostate health index (PHI) and magnetic resonance imaging (MRI) prostate in an Asian PCa screening program. Men aged 50–75 years were prospectively recruited from a community-based PSA screening program. Men with PSA 4.0–10.0 ng ml−1 had PHI result analyzed. MRI prostate was offered to men with PSA 4.0–50.0 ng ml−1 . A systematic prostate biopsy was offered to men with PSA 4.0–9.9 ng ml−1 and PHI ≥35, or PSA 10.0–50.0 ng ml−1 . Additional targeted prostate biopsy was offered if they had PI-RADS score ≥3. Clinically significant PCa (csPCa) was defined as the International Society of Urological Pathology (ISUP) grade group (GG) ≥2 or ISUP GG 1 with involvement of ≥30% of total systematic cores. In total, 12.8%(196/1536) men had PSA ≥4.0 ng ml−1. Among 194 men with PSA 4.0–50.0 ng ml−1, 187 (96.4%) received MRI prostate. Among them, 28.3%(53/187) had PI-RADS ≥3 lesions. Moreover, 7.0%(107/1536) men were indicated for biopsy and 94.4%(101/107) men received biopsy. Among the men received biopsy, PCa, ISUP GG ≥2 PCa, and csPCa was diagnosed in 42 (41.6%), 24 (23.8%), and 34 (33.7%) men, respectively. Compared with PSA/PHI pathway in men with PSA 4.0–50.0 ng ml−1, additional MRI increased diagnoses of PCa, ISUP GG ≥2 PCa, and csPCa by 21.2%(from 33 to 40), 22.2%(from 18 to 22), and 18.5%(from 27 to 32), respectively. The benefit of additional MRI was only observed in PSA 4.0–10.0 ng ml−1, and the number of MRI needed to diagnose one additional ISUP GG ≥2 PCa was 20 in PHI ≥35 and 94 in PHI <35 . Among them, 45.4%(89/196) men with PSA ≥4.0 ng ml−1 avoided unnecessary biopsy with the use of PHI and MRI. A screening algorithm with PSA, PHI, and MRI could effectively diagnose csPCa while reducing unnecessary biopsies. The benefit of MRI prostate was mainly observed in PSA 4.0–9.9 ng ml−1 and PHI ≥35 group. PHI was an important risk stratification step for PCa screening. Asian Journal of Andrology (2023) 25 , 674–679; doi: 10.4103/aja20239; published online: 02 May 2023 Keywords: magnetic resonance imaging prostate; prostate cancer; prostate health index; prostate-specific antigen; screening INTRODUCTION Prostate cancer (PCa) is the second-most common male cancer in the world,1 and its incidence in the Asia–Pacific region is increasing.2 While serum prostate-specific antigen (PSA) level remains the most common marker for screening or early diagnosis of PCa, its specificity is very low. In the European Randomized Study of Screening for Prostate Cancer (ERSPC), PSA-based screening have resulted in reduced prostate cancer-specific death and metastasis, and the number needed to screen (NNS) to prevent one prostate cancer death gradually reduced with longer follow-up time from 1410 to 570 at 16 years .3 However, problems like overbiopsy (and associated complications), overdiagnosis of indolent prostate cancers, and overtreatment still exist.4–7 These limit population-wide PCa screening around the world. The blood test prostate health index (PHI) is a formula incorporating PSA, free PSA, and [-2]proPSA (p2PSA), and it provides better prostate cancer risk stratification than PSA in men with elevated PSA level of 4.0–10.0 ng ml−1.8 Using PHI 35 as a cutoff value in Chinese men, the International Society of Urological Pathol

FAQs

What is the main goal of using PHI and MRI prostate in this screening study?

To improve detection of clinically significant prostate cancer while reducing unnecessary biopsies compared with PSA-based screening alone.

Who was included in the study population and how were participants selected?

Men aged 50–75 were recruited from a community-based PSA screening program, with PHI testing for PSA 4.0–10.0 ng ml−1 and MRI offered for PSA 4.0–50.0 ng ml−1.

How were clinically significant prostate cancers defined?

Clinically significant prostate cancer was defined as ISUP grade group (GG) ≥2, or ISUP GG 1 with involvement of ≥30% of total systematic biopsy cores.

Sep 24, 2026

Uploaded by Anna Hans