Evaluating the use of the prostate health index to risk classify early-stage

The dissertation evaluated the clinical efficacy of the prostate health index (PHI) as a diagnostic biomarker for risk-classifying early-stage prostate cancer (PCa) within a South African clinical cohort. Standard diagnostic methodologies often lack the requisite sensitivity and specificity to distinguish between indolent and aggressive disease, precipitating the overdiagnosis and overtreatment of low-risk tumours. To address this, a prospective cohort study was conducted at one of the academic hospitals, analysing serum samples from twenty-nine men with early-stage PCa. Utilising a Beckman Coulter Access 2 Immunoassay Analyser, concentrations of total Prostate Specific Antigen (tPSA), free PSA (fPSA), and [-2]proPSA were quantified to derive individual PHI scores. The predictive accuracy of these scores was subsequently assessed using multivariable logistic regression. Findings revealed that a PHI-only diagnostic model yielded the highest discriminatory capacity, achieving an Area Under the Curve (AUC) of 72.9% and a specificity of 80%. The integration of supplementary clinicopathological variables introduced statistical collinearity and diminished overall model performance. Ultimately, this research substantiates the PHI as a robust, standalone diagnostic tool capable of accurately classifying PCa aggressiveness, thereby offering significant potential to optimise personalised oncological management and mitigate overtreatment in South Africa.