{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:41:27Z","timestamp":1791312087692,"version":"4.3.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,2,6]],"date-time":"2017-02-06T00:00:00Z","timestamp":1486339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000892","name":"Prostate Cancer Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000892","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2017,12]]},"abstract":"\n Objectives<\/jats:title>\n \n To explore the utility of Prostate Health Index (\n PHI<\/jats:styled-content>\n ) density for the detection of clinically significant prostate cancer (\n PC<\/jats:styled-content>\n a) in a contemporary cohort of men presenting for diagnostic evaluation of\n PC<\/jats:styled-content>\n a.\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n The study cohort included patients with elevated prostate\u2010specific antigen (\n PSA<\/jats:styled-content>\n ; >2 ng\/\n mL<\/jats:styled-content>\n ) and negative digital rectal examination who underwent\n PHI<\/jats:styled-content>\n testing and prostate biopsy at our institution in 2015. Serum markers were prospectively measured per standard clinical pathway.\n PHI<\/jats:styled-content>\n was calculated as ([{\u22122}pro\n PSA<\/jats:styled-content>\n \/free\n PSA<\/jats:styled-content>\n ] \u00d7 [\n PSA<\/jats:styled-content>\n ]\n \u00bd<\/jats:sup>\n ), and density calculations were performed using prostate volume as determined by transrectal ultrasonography. Logistic regression was used to assess the ability of serum markers to predict clinically significant\n PC<\/jats:styled-content>\n a, defined as any Gleason score \u22657 cancer or Gleason score 6 cancer in >2 cores or >50% of any positive core.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 118 men with\n PHI<\/jats:styled-content>\n testing who underwent biopsy, 47 (39.8%) were found to have clinically significant\n PC<\/jats:styled-content>\n a on biopsy. The median (interquartile range [\n IQR<\/jats:styled-content>\n ])\n PHI<\/jats:styled-content>\n density was 0.70 (0.43\u20131.21), and was 0.53 (0.36\u20130.75) in men with negative biopsy or clinically insignificant\n PC<\/jats:styled-content>\n a and 1.21 (0.74\u20131.88) in men with clinically significant\n PC<\/jats:styled-content>\n a (\n P<\/jats:italic>\n < 0.001). Clinically significant\n PC<\/jats:styled-content>\n a was detected in 3.6% of men in the first quartile of\n PHI<\/jats:styled-content>\n density (<0.43), 36.7% of men in the\n IQR<\/jats:styled-content>\n of\n PHI<\/jats:styled-content>\n density (0.43\u20131.21), and 80.0% of men with\n PHI<\/jats:styled-content>\n density >1.21 (\n P<\/jats:italic>\n < 0.001). Using a threshold of 0.43,\n PHI<\/jats:styled-content>\n density was 97.9% sensitive and 38.0% specific for clinically significant\n PC<\/jats:styled-content>\n a, and 100% sensitive for Gleason score \u22657 disease. Compared with\n PSA<\/jats:styled-content>\n (area under the curve [\n AUC<\/jats:styled-content>\n ] 0.52),\n PSA<\/jats:styled-content>\n density (\n AUC<\/jats:styled-content>\n 0.70), %free\n PSA<\/jats:styled-content>\n (\n AUC<\/jats:styled-content>\n 0.75), the product of %free\n PSA<\/jats:styled-content>\n and prostate volume (\n AUC<\/jats:styled-content>\n 0.79), and\n PHI<\/jats:styled-content>\n (\n AUC<\/jats:styled-content>\n 0.76),\n PHI<\/jats:styled-content>\n density had the highest discriminative ability for clinically significant\n PC<\/jats:styled-content>\n a (\n AUC<\/jats:styled-content>\n 0.84).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Based on the present prospective single\u2010centre experience,\n PHI<\/jats:styled-content>\n density could be used to avoid 38% of unnecessary biopsies, while failing to detect only 2% of clinically significant cancers.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.13762","type":"journal-article","created":{"date-parts":[[2017,1,6]],"date-time":"2017-01-06T02:16:48Z","timestamp":1483669008000},"page":"793-798","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Prostate Health Index density improves detection of clinically significant prostate cancer"],"prefix":"10.1111","volume":"120","author":[{"given":"Jeffrey J.","family":"Tosoian","sequence":"first","affiliation":[{"name":"Department of Urology James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha C.","family":"Druskin","sequence":"additional","affiliation":[{"name":"Department of Urology James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore MD 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