A Combinatorial Neural Network Analysis Reveals a Synergistic Behaviour of Multiparametric Magnetic Resonance and Prostate Health Index in the Identification of Clinically Significant Prostate Cancer

Published:April 28, 2022DOI:



      The widespread use of prostate specific antigen (PSA) caused high rate of overdiagnosis. Overdiagnosis leads to unnecessary definitive treatments of prostate cancer (PCa) with detrimental side effects, such as erectile dysfunction and incontinence. The aim of this study was to evaluate the feasibility of an artificial neural network-based approach to develop a combinatorial model including prostate health index (PHI) and multiparametric magnetic resonance (mpMRI) to recognize clinically significant PCa at initial diagnosis.


      To this aim we prospectively enrolled 177 PCa patients who underwent radical prostatectomy and had received PHI tests and mpMRI before surgery. We used artificial neural network to develop models that can identify aggressive PCa efficiently. The model receives as an input PHI plus PI-RADS score.


      The output of the model is an estimate of the presence of a low or high Gleason score. After training on a dataset of 135 samples and optimization of the variables, the model achieved values of sensitivity as high as 80% and 68% specificity.


      Our preliminary study suggests that combining mpMRI and PHI may help to better estimate the risk category of PCa at initial diagnosis, allowing a personalized treatment approach. The efficiency of the method can be improved even further by training the model on larger datasets.


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        • Barsouk A
        • Padala SA
        • Vakiti A
        • et al.
        Epidemiology, staging and management of prostate cancer.
        Med Sci (Basel). 2020; 8
        • Litwin MS
        • Tan HJ
        The diagnosis and treatment of prostate cancer: a review.
        JAMA. Jun 27 2017; 317: 2532-2542
        • Mottet N
        • van den Bergh RCN
        • Briers E
        • et al.
        EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent.
        Eur Urol. 2020;
        • Valerio M
        • Ahmed HU
        • Emberton M
        • et al.
        The role of focal therapy in the management of localised prostate cancer: a systematic review.
        Eur Urol. 2014; 66: 732-751
        • Rapisarda S
        • Bada M
        • Crocetto F
        • et al.
        The role of multiparametric resonance and biopsy in prostate cancer detection: comparison with definitive histological report after laparoscopic/robotic radical prostatectomy.
        Abdom Radiol (NY). 2020; 45: 4178-4184
        • Eldred-Evans D
        • Tam H
        • Smith APT
        • Winkler M
        • Ahmed HU
        Use of imaging to optimise prostate cancer tumour volume assessment for focal therapy planning.
        Curr Urol Rep. 2020; 21: 38
        • Ferro M
        • De Cobelli O
        • Lucarelli G
        • et al.
        Beyond PSA: the role of prostate health index (phi).
        Int J Mol Sci. 2020; 21
        • Ferro M
        • Crocetto F
        • Bruzzese D
        • et al.
        Prostate health index and multiparametric MRI: partners in crime fighting overdiagnosis and overtreatment in prostate cancer.
        Cancers (Basel). 2021; 13
        • Tuck MK
        • Chan DW
        • Chia D
        • et al.
        Standard operating procedures for serum and plasma collection: early detection research network consensus statement standard operating procedure integration working group.
        J Proteome Res. 2009; 8: 113-117
        • Gentile F
        • Ferro M
        • Della Ventura B
        • et al.
        Optimized identification of high-grade prostate cancer by combining different psa molecular forms and psa density in a deep learning model.
        Diagnostics (Basel). 2021; 11
        • Gnanapragasam VJ
        • Burling K
        • George A
        • et al.
        The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population.
        Sci Rep. 2016; 6: 35364
        • Hsieh PF
        • Li WJ
        • Lin WC
        • et al.
        Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population.
        World J Urol. 2020; 38: 1207-1214
        • Massanova M
        • Robertson S
        • Barone B
        • et al.
        The comparison of imaging and clinical methods to estimate prostate volume: a single-centre retrospective study.
        Urol Int. 2021; 105: 804-810
        • Hsieh PF
        • Li TR
        • Lin WC
        • et al.
        Combining prostate health index and multiparametric magnetic resonance imaging in estimating the histological diameter of prostate cancer.
        BMC Urol. 2021; 21: 161
        • Stejskal J
        • Adamcova V
        • Zalesky M
        • et al.
        The predictive value of the prostate health index vs. multiparametric magnetic resonance imaging for prostate cancer diagnosis in prostate biopsy.
        World J Urol. 2021; 39: 1889-1895
        • Fan YH
        • Pan PH
        • Cheng WM
        • et al.
        The prostate health index aids multi-parametric MRI in diagnosing significant prostate cancer.
        Sci Rep. 2021; 11: 1286
        • Druskin SC
        • Tosoian JJ
        • Young A
        • et al.
        Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer.
        BJU Int. 2018; 121: 619-626
        • Schwen ZR
        • Mamawala M
        • Tosoian JJ
        • et al.
        Prostate Health Index and multiparametric magnetic resonance imaging to predict prostate cancer grade reclassification in active surveillance.
        BJU Int. 2020; 126: 373-378