DOI: https://doi.org/10.36347/sasjs.2026.v12i05.010

Pages: 385-391

Background: Prostate-specific antigen (PSA), although widely used for early detection, demonstrates limited specificity in the 4–10 ng/ml “grey zone,” frequently resulting in unnecessary prostate biopsies and associated morbidity. The Prostate Health Index (PHI), derived from [-2] proPSA, free PSA (fPSA), and total PSA (tPSA) using the formula ([-2] proPSA/fPSA) × √tPSA, has been proposed to improve diagnostic discrimination in this subgroup. Materials and Methods: This one-year prospective comparative cross-sectional study was conducted at the Urology Division of Jos University Teaching Hospital. Men presenting with PSA levels between 4 – 10 ng/ml, regardless of symptoms or digital rectal examination (DRE) findings, were enrolled. Participants underwent clinical evaluation, DRE, measurement of [-2] proPSA, fPSA, and tPSA, and PHI calculation. All subjects subsequently underwent digitally guided transrectal prostate biopsy. Histologically confirmed adenocarcinoma was the primary outcome. Receiver Operating Characteristic (ROC) curve analysis was used to assess diagnostic performance. Statistical significance was set at p < 0.05. Results: Forty-two men (mean age 69.5 ± 9.5 years) were included. Prostate adenocarcinoma was detected in 5 patients (12%). Median PSA and PHI values were 7.0 ng/ml (IQR 5.0–9.5) and 12.1 (IQR 7.5–17.7), respectively. DRE findings showed a significant association with histological outcome (p=0.000). Although higher PSA and PHI values were observed in cancer cases, these associations were not statistically significant (p= 0.250 and 0.405, respectively). PHI demonstrated superior discriminative ability compared to PSA (AUC 0.668 vs. 0.538). A PHI cut-off value of 8.83 yielded 100% sensitivity and 35% specificity (p=0.236). Conclusion: PHI demonstrated improved diagnostic performance over PSA in men with intermediate PSA levels, although not statistically significant. PHI may serve as a useful adjunctive biomarker to reduce unnecessary prostate