{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:20:06Z","timestamp":1790101206854,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the diagnostic performance of the Prostate Health Index (phi) in detecting clinically significant prostate cancer (csPC) among men within the PSA gray zone (2.01\u201310.00\u2009ng\/mL), compared with total PSA and the free\u2010to\u2010total PSA ratio (F\/T ratio), using a population\u2010based screening database in Kanazawa city, Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 2019 and 2023 (excluding 2022), 14\u2009840 men participated in a biennial population\u2010based prostate cancer screening program in Kanazawa city, Japan. Among them, 2776 men with PSA levels of 2.01\u201310.00\u2009ng\/mL were identified, and 571 men who underwent prostate biopsy were included in the final analysis. The diagnostic accuracy for detecting csPC was compared among PSA, the F\/T ratio, and phi using receiver operating characteristic (ROC) and decision curve analyses (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The area under the ROC curve (AUC) for detecting csPC was 0.691 for PSA, 0.673 for F\/T ratio, and 0.761 for phi. The AUC for phi was significantly higher than that for F\/T ratio (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The DCA demonstrated that phi provided the greatest net benefit across threshold probabilities between 0.2 and 0.6, indicating improved clinical utility for csPC detection in the gray zone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In population\u2010based screening, adding phi to PSA and F\/T ratio improved discrimination for csPC and may reduce unnecessary referrals and improve screening efficiency among men in the PSA gray zone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70409","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T06:41:47Z","timestamp":1773988907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Validation of the Prostate Health Index for Detecting Clinically Significant Prostate Cancer in a Population\u2010Based Screening Program"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3188-8834","authenticated-orcid":false,"given":"Hiroshi","family":"Yaegashi","sequence":"first","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"},{"name":"Kanazawa Medical Association  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3197-9234","authenticated-orcid":false,"given":"Kazufumi","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Kanazawa Medical Association  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotaro","family":"Miwa","sequence":"additional","affiliation":[{"name":"Kanazawa Medical Association  Kanazawa Ishikawa 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