Year : 2015  |  Volume : 17  |  Issue : 6  |  Page : 1017-1021

Percent free prostate-specific antigen is effective to predict prostate biopsy outcome in Chinese men with prostate-specific antigen between 10.1 and 20.0 ng ml−1

1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
2 Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
3 Department of Health Care, PLA Headquarters of the General Staff Guard Bureau, Beijing 100017, China
4 Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China
5 Department of Urology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200127, China
6 Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an 710061, China
7 Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
8 Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
9 State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
10 Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
11 Department of Urology, Huadong Hospital, Fudan University, Shanghai 20040, China
12 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
13 Department of Urology, Peking University Third Hospital, Beijing 100083, China
14 Department of Urology, Tenth People's Hospital, Tongji University, Shanghai 200072, China
15 Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
16 Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai 200032, China
17 Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
18 Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
19 Department of Urology, Peking University People's Hospital, Beijing 100044, China
20 Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
21 Department of Urology, Third Hospital of Sun Yat-Sen University, Guangzhou 510630, China
22 Department of Urology, Zhujiang Hospital, Southern Medical University, Guangdong 510282, China
23 Department of Urology, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, China

Correspondence Address:
Ying-Hao Sun
Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, 200433
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1008-682X.150846

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Percent free prostatic-specific antigen (%fPSA) has been introduced as a tool to avoid unnecessary biopsies in patients with a serum PSA level of 4.0-10.0 ng ml−1 , however, it remains controversial whether %fPSA is effective in PSA range of 10.1-20.0 ng ml−1 in both Chinese and Western population. In this study, the diagnostic performance of %fPSA and serum PSA in predicting prostate cancer (PCa) and high-grade PCa (HGPCa) was analyzed in a multi-center biopsy cohort of 5915 consecutive Chinese patients who underwent prostate biopsy in 22 hospitals across China from January 1, 2010 to December 31, 2013. The indication for biopsy was PSA>4.0 ng ml−1 or/and suspicious digital rectal examination. Total and free serum PSA determinations were performed by three types of electrochemiluminescence immunoassays with recalibration to the World Health Organization standards. The diagnostics accuracy of PSA, %fPSA and %fPSA in combination with PSA (%fPSA + PSA) was determined by the area under the receivers operating characteristic curve (AUC). %fPSA was more effective than PSA in men aged ≥60 years old. The AUC was 0.584 and 0.635 in men aged ≥60 years old with a PSA of 4.0-10.0 ng ml−1 and 10.1-20.0 ng ml−1 , respectively. The AUC of %fPSA was superior to that of PSA in predicting HGPCa in patients ≥60 years old in these two PSA range. Our results indicated that %fPSA is both statistically effective and clinical applicable to predict prostate biopsy outcome in Chinese patients aged ≥60 years old with a PSA of 4.0-10.0 ng ml−1 and 10.1-20.0 ng ml−1 .

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