Introduction

Currently [-2]proPSA (proPSA) and the Prostate Health Index (PHI) play a role in diagnosing prostate cancer by influencing a clinicians decision in deciding whether a patient should be subjected to a prostate biopsy. However, their clinical utility is somewhat limited due to their inability to discriminate cancer from non-cancer, as well as cancer that is aggressive versus cancer that is not. This literature review looked at proPSA and PHI, and how they are used in a clinical environment.

Method

The latest journal articles focusing on the clinical utility of proPSA and PHI where reviewed.

Results

Current studies suggest that proPSA is better at discriminating aggressive cancer versus non aggressive cancer. PHI provides an improvement on evaluating risk of prostate cancer than usage of a free/total PSA ratio on its own. According to Beckman-Coulter the use of PHI has been estimated to reduce the outcome of negative biopsies but approximately 18-19% however larger scales studies need to be conducted for this to be confirmed. Currently there is no protocol in place to evaluate patients that yield medium risk scores. Usage of these markers may result in overdiagnosis and overtreatment.

Conclusion

Although proPSA and the PHI are not very discriminatory, clinicians still rely heavily on their results. However, there is slight improvement in sensitivity and specificity of PHI when compared with total/free PSA. However the results of proPSA and PHI are still just an assessment on risk which will never be definitive. Calls for larger scale studies to assess the true benefits of PHI and proPSA still need to be met, until then proPSA and PHI must be used with caution.