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PHI - Based Prostate Cancer Smart Screening Analysis
Considering Prostate Health Index (PHI)? High PHI? | Before prostate cancer biopsy: analyze your PSA trend, use new screening technology and consider smart screening strategy analysis.
PSA is the prostate-specific antigen blood test measured in ng/mL that reflects prostate conditions.
Learn more about your elevated or high PSA test level:
Free PSA is the component of PSA not bound to proteins ("free") measured in ng/mL.
Free PSA % is the ratio of Free PSA to PSA that is used with elevated or high PSA test levels to increase screening effectiveness. See our Free PSA page that opens in a new window.
To improve on PSA and Free PSA screening for prostate cancer, Beckman Coulter supplies the Prostate Health Index (PHI) to commercial labs that process your blood.
Learn more about Prostate Smart Screening for Cancer at our home page in a new window
Take Next Steps to Develop Your Smart Screening Strategy
- Understand your "Underlying" "True" PHI and elevated or high PSA.
- Why does PHI improve PSA screening effectiveness?
- Interpret your PHI, elevated or high PSA and prostate volume.
- Analyze your elevated or high PSA trend and high PHI trend.
- Compare PHI to other enhanced tests - blood or urine.
- Develop Prostate Smart screening strategy for your PHI level.
1. Understand Your "Underlying" "True" PHI and Elevated or High PSA
An elevated PSA (less than 5.0) or a high PSA (greater than 5.0) provide early warning of prostate activity for a smart prostate cancer screening strategy. (Links take you to one of our website pages that opens in a new window.)
A corresponding high PHI provides additional early warning because high PHI is associated with higher probabilities of prostate cancer found by biopsy.
Your "Underlying" "True" PSA and PHI are the values that your physicians should use to assess your risk with the help of prostate cancer risk calculators or rules of thumb about threshold level of concern. Learn about risk calculators in the Blog post: Use prostate cancer risk calculators to avoid premature biopsy that opens in a new window.
Your "True" PSA is Hybritech calibrated and adjusted for specific medications to treat prostate enlargement (BPH). See the Blog post: Elevated PSA? Is your "True" PSA higher? that opens in a new window.
Your "True" PHI is already Hybritech calibrated for use with the ERSPC Risk Calculator and popular look-up tables.
Your "Underlying" "True" PSA test level may be lower than your most recent "True" elevated PSA value because of temporary infection, inflammation or aggravation of your prostate. See the Blog post: Elevated PSA? Is your "Underlying" PSA lower? that opens in a new window.
Your "Underlying" "True" PHI may be lower than your most recent "True" PHI for the same reasons, especially Infections of the prostate and urinary tract that tend to decrease the Free PSA % component of PHI when they increase PSA.
Follow-up testing is highly recommended for a long enough period for a possible infection to clear. See the Blog post: "Underlying" Free PSA, Prostate Health Index (PHI), 4Kscore, PCA3 in a new window.
2. Why Does PHI Improve PSA Screening Effectiveness?
PHI improves prostate cancer screening effectiveness compared to PSA alone by incorporating PSA, Free PSA and Pro2PSA [isoform of Free PSA] blood test results into a formula. Each test responds differently to prostate cancer and non-cancer prostate conditions, and the different responses improve prostate cancer screening.
3. Interpret Your PHI, Elevated or High PSA and Prostate Volume
For any PSA level, the probability of cancer increases as PHI increases.
What Is the Probability of Significant Cancer for PHI and PSA Levels?
Only the overall probability of cancer is reported for four ranges of PHI shown on the Beckman Coulter website based on a 2015 study of PHI in the Journal of Urology (PubMed abstract will open in a new window). The probability of high-grade cancer is not reported, although it is related to the overall probability.
The highly regarded ERSPC Risk Calculator estimates the probability of significant prostate cancer (high-grade and large low-grade) and the probability of any prostate cancer. There you will learn of the many factors that affect the probability of prostate cancer. We use the ERSPC-RC to estimate probabilities of significant prostate cancer.
Notice that the probability of significant cancer increases steeply as Free PHI increases. The three curves show that the probability increases modestly as PSA increases because PSA is also considered by PHI.
What Is the Probability of Significant Cancer for PHI and Prostate Volume?
Using the ERSPC-RC, we focus next on PHI and prostate volume for men with no other risk factors. For PSA 3.0, the graph on the right plots the probability significant prostate cancer will be found by biopsy as a function of PHI for three prostate volumes estimated by digital rectal exam (DRE): small (25cc), medium (40cc) and large (60cc).
Notice that the probabilities are much higher for a small prostate (the top red curve) than for a large prostate (the bottom blue curve). The probability of cancer is lower for large prostates because they tend to produce more PSA that "explains" elevated levels of PSA.
The dramatic difference in risk for small and large prostates demonstrates why it is so important to consider prostate volume for elevated PSA levels. The risk level of 10% is the same at 8 PHI for a small prostate as at 31 PHI for a large prostate. Full interpretation of PHI depends on prostate volume.
Ask your physician to estimate your prostate volume by digital rectal exam (DRE). Ask for a transrectal ultrasound (TRUS) to measure your prostate volume more accurately before considering a biopsy. To learn more see our Ultrasound-Based Prostate Cancer Smart Screening Analysis page in a new window.
4. Analyze Your Elevated or High PSA Trend and High PHI Trend
Analysis of your PSA trend and PHI trend can provide valuable insights. See our Analyze Your Elevated or High PSA Trend and Free PSA % Trend page and our "Underlying" Free PSA, Prostate Health Index (PHI), 4Kscore, PCA3 Blog post in new windows.
Free PSA and PSA are two of the three key components of PHI. Although the effects of infection on PHI have not been studied, there is analysis of the effects of infection on PSA and Free PSA %.
For example, some men experience periodic infections of the prostate or urinary tract that cause their PSA to increase temporarily and their Free PSA % to decrease temporarily It would be a big mistake to use a temporarily increased PSA and decreased Free PSA % to assess underlying prostate cancer risk or estimate growth rate in PSA from cancer.
5. Compare Prostate Health Index (PHI) to Other Enhanced Tests - Blood or Urine
Enhanced blood tests used with prostate cancer risk calculators can substantially improve prostate cancer screening effectiveness compared to PSA alone. We describe and compare six combinations of enhanced blood and urine tests and risk calculators. See our Compare PSA, Free PSA, PHI, 4Kscore, PCA3 page in a new window for our full comparison.
The Prostate Health Index (PHI) is one of several enhanced test alternatives for prostate cancer screening.
Free PSA and 4Kscore blood tests and PCA3 urine test are alternative enhanced tests that you can learn about in new windows.
Six Enhanced Test Combinations for Elevated and High PSA Test Levels (T1 to T6)
We consider six enhanced test combinations of blood and urine tests and risk calculators:
The two PHI enhanced test combinations (T3 and T4) are described below:
T3. Prostate Health Index (PHI) Blood Tests, Calculation and Report
Beckman Coulter supplies the Prostate Health Index (PHI) to commercial labs that process your blood.
You must operate the ERSPC Risk Calculator to estimate the probability of high-grade cancer as a continuous variable.
T4. Prostate Health Index (PHI) Blood Tests, Calculation and ERSPC Risk Calculator
The highly regarded ERSPC Risk Calculator considers PHI along with your PSA, digital rectal exam (DRE) result, DRE prostate volume, prior biopsy result and TRUS ultrasound prostate volume and cancer suspicion. See Section 3 above.
Comparison of Enhanced Test Combinations for Elevated and High PSA Test Levels
We compare the six enhanced test combinations in five ways:
See our Compare PSA, Free PSA, PHI, 4Kscore, PCA3 page in a new window for our full comparison.
Cost and Reimbursement
Rough estimates of cost and reimbursement of the blood and urine tests:
We encourage you to plan ahead when considering cost and reimbursement. Ideally, you may choose an:
Moreover, your health insurance carrier may resist follow-up and periodic or annual enhanced tests, especially if the price is high.
Summary Comparison and Suggestions for Elevated or High PSA
There are three best enhanced test options with ranking based on what is important to you. Consideration of prostate volume (or not) is the biggest difference between PHI with ERSPC Risk Calculator using prostate volume and other alternatives.
If you are willing to operate the ERSPC Risk Calculator (and especially if either cost or consideration of prostate volume and TRUS ultrasound results are important to you) then consider:
If you are not willing to operate the ERSPC Risk Calculator and cost is not important to you then consider:
If you are not willing to operate the ERSPC Risk Calculator and cost is important to you then consider:
If you are concerned about operating the ERSPC Risk Calculator, we encourage you to enlist the help of a daughter, son, spouse or friend or even pay a student with computer skills.
Alternatively, we can operate the ERSPC Risk Calculator for you and create a full smart prostate cancer screening strategy report for you. Learn more about Prostate Smart Screening for Cancer at our home page in a new window.
6. Develop Your Prostate Smart Screening Strategy for Your PHI Level
For men who want to lead a collaborative team effort rather than be a passive patient.
Prostate Smart analysis helps you create your strategy with your collaborative team of physicians and confidants to minimize your risks of:
> Regrettably late diagnosis of deadly cancer:
> Premature biopsy, diagnosis, treatment and side effects:
Analysis is needed to create the best personal screening strategy for you because:
We analyze published studies and present the implications for personal decisions. Studies are from: Mayo Clinic, Cleveland Clinic, Johns Hopkins, Memorial Sloan Kettering, NIH, NYU, UCLA, UC London, Yale and more.
Learn more about PSA-Based Prostate Smart Screening Strategy Analysis in a new window.
Return to Prostate Smart Screening for Cancer home page.