As Men’s Health Month progresses, we’re continuing to share how men can better take control of their health by being knowledgeable about one of the most common cancers among men: prostate cancer. In our last article, we discussed when men should get a prostate exam and what they can expect. This week, we’re discussing the Prostate Health Index (PHI), a powerful tool for improving prostate cancer detection.
While traditional screening tools like the DRE and PSA we discussed last week have long been used to detect prostate issues, they are not without their limitations. That’s where the PHI test and score come in. This test can help providers differentiate between benign prostate conditions and more serious concerns like prostate cancer.
Keep reading to better understand how your PHI score can provide greater clarity and reduce the chance of an unnecessary biopsy.
Key Takeaways
- The Prostate Health Index (PHI) is a blood test that improves prostate cancer detection.
- PHI combines three PSA markers for prostate cancer: total PSA, free PSA, and p2PSA.
- A higher PHI score indicates a higher probability of prostate cancer.
- PHI can help reduce the chance of unnecessary prostate biopsies.
What Is the Prostate Health Index (PHI)?
Approved by the FDA in 2012, the PHI test is a next-generation blood test that was developed to more accurately assess a man’s risk of having prostate cancer. It combines three biomarkers to improve on the traditional PSA test. Those three biomarkers include:
- Total PSA: This test measures the overall level of prostate-specific antigen in your blood.
- Free PSA: This test measures the free, or unbound, PSA in your blood.
- p2PSA: This test measures the -2 pro PSA in your blood, and studies show elevated levels to be an indication of cancer.
Your PHI score is calculated based on the amount of each PSA, creating a far more predictive analysis than the traditional PSA test alone. According to studies published by the National Institutes of Health and Beckman Coulter, the creator of the test, PHI increases specificity and reduces false positives, making it a valuable addition to urologists’ testing methods.
Why Is the PHI More Reliable Than PSA Alone?
The problem with the PSA test alone is that it can often be inaccurate, especially in the 4 to 10 ng/mL range, which is commonly referred to as the diagnostic gray zone. Within this range, elevated PSA levels could be caused by benign conditions like prostatitis or benign prostatic hyperplasia (BPH), but it can still lead to unnecessary anxiety or invasive procedures.
The PHI test helps increase a provider’s certainty that cancer may be present. Factoring in p2PSA levels plays a significant role in the PHI test, helping it provide more accurate results. The [-2]proPSA biomarker is an isoform that is more closely linked to cancerous tissue. By factoring in [-2]proPSA levels, PHI offers improved sensitivity and specificity, allowing physicals to better distinguish between malignant and benign causes of elevated PSA.
What Does Your PHI Score Mean?
Once you’ve had your blood drawn to administer the PHI test, your doctor will go over your results with you. PHI scores are categorized into the following ranges to determine prostate cancer risk.
- PHI <27: This range is low risk and indicates cancer is unlikely.
- PHI 27–35: This range indicates moderate risk, and more clinical evaluation is recommended.
- PHI >35: This range indicates high risk and is strongly suggestive of prostate cancer.
You should also bear in mind that PHI is not a standalone diagnostic tool. Instead, it should be used as part of a broader range of diagnostic methods, including a DRE, family history knowledge, age, and other clinical findings.
How Do Physicians Use PHI?
Physicians will often use a patient’s PHI score to guide their decisions about whether or not to conduct a prostate biopsy. In fact, a study published in Nature’s Prostate Cancer and Prostatic Diseases journal found that physicians used a patient’s PHI score to shape their management plan in 73% of cases. This includes opting to defer biopsies when the patient had a low PHI and deciding to perform biopsies when the patient had a PHI ≥36.
This is especially valuable because biopsies can be painful, increase the risk of infection, and sometimes lead to overtreating slow-growing tumors that may never become life-threatening. The same study found in Nature also determined that when a patient’s PHI score was included in their assessment, the number of biopsies performed dropped from 60% of men to 36% of men without compromising cancer detection. This statistic shows that PHI helps patients avoid invasive procedures when they’re not truly needed, offering peace of mind and preserving their quality of life.
Who Should Consider a PHI Test?
So, who should get a PHI test? The guidelines remain similar to those for a prostate exam, with a few additions.
- Men 50 years or older with PSA levels between 4–10 ng/mL.
- Men with a family history of prostate cancer.
- Men whose PSA results are inconclusive or borderline.
Receiving your PHI score can be especially useful if you’re trying ot make an informed decision about whether to undergo a biopsy or if increased observation will suffice.
Speak with an RMC Urologist About Your PHI Score
If you’ve received an abnormal PSA result or you’re experiencing urinary symptoms, you don’t have to wait to get answers. RMC’s urology team is ready to help you understand your options, including whether the Prostate Health Index (PHI) test is right for you.
Our board-certified urologists have the cutting-edge tools and years of experience necessary to create a customized care plan for each patient. Whether you need advanced diagnostics or more guidance as you decide whether or not to have a biopsy, we’re ready to support you every step of the way. Contact RMC today to schedule an appointment and confidently take control of your prostate health.