You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2018MP12-20 PROSTATE HEALTH INDEX AND MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING TO PREDICT PROSTATE CANCER GRADE RECLASSIFICATION IN ACTIVE SURVEILLANCE Zeyad Schwen, Mufaddal Mamawala, Jeffrey Tosoian, Sasha Druskin, Ashley Ross, Lori Sokoll, Jonathan Epstein, Christian Pavlovich, and H. Ballentine Carter Zeyad SchwenZeyad Schwen More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Sasha DruskinSasha Druskin More articles by this author , Ashley RossAshley Ross More articles by this author , Lori SokollLori Sokoll More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.407AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate Health Index (PHI) and multiparametric magnetic resonance imaging (mpMRI) have independently been shown to be valuable tools for predicting prostate cancer (PCa) grade reclassification (GR, Gleason score > 6) in patients enrolled in active surveillance (AS). We aimed to identify the value of combining PHI or PHI density (PHID) with mpMRI for the purpose of predicting GR at next surveillance biopsy in order to reduce unnecessary biopsies in AS. METHODS We retrospectively identified 205 men in the Johns Hopkins AS program with a median follow-up of 2 years. (IQR 1- 4 years) who underwent a mpMRI and PHI within 6 months of each other followed by a systematic +/- mpMRI-TRUS fusion targeted prostate biopsy. PHI and PHID were evaluated across PI-RADS V2.0 scores and compared between men with and without GR to Gleason score > 6. The negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) were calculated to compare the diagnostic value of PI-RADS score combined with PHI, PHID, or PSAD for GR using the cohort 25th percentile value as a threshold. RESULTS Of the 205 men, 27 men (13%) experienced GR. The median (IQR) PHI, PHID and PSAD was 32.0 (24.4 - 42.3), 0.57 (0.37 - 0.89) and 0.11 (0.07 - 0.16), respectively. Men with GR had a higher median PHI (34.6 vs. 31.6, p= 0.03) and PHID (0.79 vs. 0.56, p = 0.03) as compared to men without GR, while PSA and PSAD were not significantly different between men with and without GR. Overall, 150/205 (73%) men had PIRADS ≤3, which had a NPV of 91% for GR (AUC 0.66). Using a PHI cut-off of 24.4 in combination with PIRADS ≤3, the NPV and AUC were both increased to 98% and 0.70, respectively. While using a PHID cut-off of 0.37 in addition to PIRADS ≤3, the NPV was 91% with an AUC of 0.67. Combining PI-RADS and a PSAD threshold of 0.07 yielded an AUC of 0.67 and NPV of 93%. Ultimately, the combined use of PHI < 24.4 and PIRADS ≤3 could have avoided 24% of AS biopsies at the cost of missing only 4% of GRs. CONCLUSIONS PHI and mpMRI in combination are valuable tools for AS that can predict GR at next surveillance biopsy more accurately than either mpMRI or PHI alone. Together, PHI and mpMRI may be useful for decreasing the burden of surveillance prostate biopsies. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e144 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zeyad Schwen More articles by this author Mufaddal Mamawala More articles by this author Jeffrey Tosoian More articles by this author Sasha Druskin More articles by this author Ashley Ross More articles by this author Lori Sokoll More articles by this author Jonathan Epstein More articles by this author Christian Pavlovich More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...