A major focus in urologic research is the identification of new biomarkers with improved specificity for clinically-significant prostate cancer. A promising new test based on prostate-specific antigen (PSA) is called the Prostate Health Index (PHI), which has recently been approved in the United States, Europe and Australia.
PHI is a mathematical formula that combines total PSA, free PSA and [-2] proPSA. PHI is calculated using the following formula: ([-2]proPSA/free PSA) × √PSA. Intuitively حدسي, this formula makes sense, in that men with a higher total PSA and p2PSA with a lower free PSA are more likely to have clinically significant prostate cancer.
PHI also predicts the likelihood of progression during active surveillance, providing another noninvasive modality to potentially select and monitor this patient population. This article reviews the evidence on this new blood test with significant promise for both prostate cancer screening and treatment decision-making.
Although no single marker in isolation has perfect performance characteristics, PHI (Prostate Health Index) is a simple and inexpensive blood test that should be used as part of a multivariable approach to screening. In multiple prospective international trials, this composite measurement has been shown to outperform conventional PSA and free PSA measurements. Unlike PCA3 and TMPRSS2:ERG, PHI is also consistently associated with Gleason score and upgrading during active surveillance. PHI should be considered as part of the standard urologic armamentarium for biopsy decisions, risk stratification and treatment selection.