. 2015 Jun 19;10(6):e0130308.

doi: 10.1371/journal.pone.0130308. eCollection 2015.

Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml

Rui Chen¹, Yiran Huang², Xiaobing Cai³, Liping Xie⁴, Dalin He⁵, Liqun Zhou⁶, Chuanliang Xu¹, Xu Gao¹, Shancheng Ren¹, Fubo Wang¹, Lulin Ma⁷, Qiang Wei⁸, Changjun Yin⁹, Ye Tian¹⁰, Zhongquan Sun¹¹, Qiang Fu¹², Qiang Ding¹³, Junhua Zheng¹⁴, Zhangqun Ye¹⁵, Dingwei Ye¹⁶, Danfeng Xu¹⁷, Jianquan Hou¹⁸, Kexin Xu¹⁹, Jianlin Yuan²⁰, Xin Gao²¹, Chunxiao Liu²², Tiejun Pan²³, Yinghao Sun¹; Chinese Prostate Cancer Consortium

Collaborators, Affiliations

Collaborators

Chinese Prostate Cancer Consortium:
Jianfeng Xu, Jian Huang, Xiangbo Kong, Yuanjie Niu, Linhui Wang, Tie Zhou, Leye He, Wanhan Xu, Benkang Shi, Zhaozhao Liang, Gongxian Wang, Zhiping Wang, Yangliang Deng

Affiliations

¹ Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
² Renji Hospital, Shanghai Jiao Tong University, School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, 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, Qingchun Road 79, Hangzhou 310003, Zhejiang Province, China.
⁵ Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277 west Yanta Road, Xi'an 710061, China.
⁶ Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
⁷ Department of Urology, Peking University Third Hospital, No 49,North Garden Road, Haidian Dist, Beijing, China.
⁸ Department of Urology, West China Hospital, Sichuan University, Guoxuexiang 37# 610041, Chengdu Sichuan, China.
⁹ State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; No.300 Guangzhou Road, Nanjing, Jiangsu Province, China; Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; No.300 Guangzhou Road, Nanjing, Jiangsu Province, China.
¹⁰ Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
¹¹ Department of Urology, Huadong Hospital, Fudan University, #221 West Yan'an Road, Shanghai 20040, China.
¹² Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd.600 Shanghai, China.
¹³ Huashan Hospital, Fudan University, No. 12, WuLuMuQi Middle Road, Shanghai, 200040, China.
¹⁴ Department of Urology, Tenth People's Hospital; Tongji University, Shanghai, China.
¹⁵ Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, 430030, China.
¹⁶ Fudan University Shanghai Cancer Center and Department of Oncology, #270 Dong An Road, Shanghai, 200032, China.
¹⁷ Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
¹⁸ The First Affiliated Hospital of Soochow University, 188 ShiZhi Road, Suzhou, 215006, China.
¹⁹ Peking University People's Hospital, 11 Xizhomen South Street, Beijing, 100044, China.
²⁰ Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 Changlexi Road, Xi'an, 710032 China.
²¹ Department of Urology, 3rd Hospital of Sun Yat-Sen University, Tiehe Road 600#, Guangzhou, 510630, China.
²² Department of Urology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Road, Haizhu District, Guangzhou, Guangdong, 510282, China.
²³ Department of Urology, Wuhan General Hospital of Guangzhou Military Command, No. 627 Wuluo Rd, Wuhan, Hubei 430070, China.

PMID: 26091007
PMCID: PMC4474838
DOI: 10.1371/journal.pone.0130308

Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml

Rui Chen et al. PLoS One. 2015.

. 2015 Jun 19;10(6):e0130308.

doi: 10.1371/journal.pone.0130308. eCollection 2015.

Authors

Collaborators

Chinese Prostate Cancer Consortium:
Jianfeng Xu, Jian Huang, Xiangbo Kong, Yuanjie Niu, Linhui Wang, Tie Zhou, Leye He, Wanhan Xu, Benkang Shi, Zhaozhao Liang, Gongxian Wang, Zhiping Wang, Yangliang Deng

Affiliations

¹ Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
² Renji Hospital, Shanghai Jiao Tong University, School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, 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, Qingchun Road 79, Hangzhou 310003, Zhejiang Province, China.
⁵ Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277 west Yanta Road, Xi'an 710061, China.
⁶ Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
⁷ Department of Urology, Peking University Third Hospital, No 49,North Garden Road, Haidian Dist, Beijing, China.
⁸ Department of Urology, West China Hospital, Sichuan University, Guoxuexiang 37# 610041, Chengdu Sichuan, China.
⁹ State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; No.300 Guangzhou Road, Nanjing, Jiangsu Province, China; Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; No.300 Guangzhou Road, Nanjing, Jiangsu Province, China.
¹⁰ Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
¹¹ Department of Urology, Huadong Hospital, Fudan University, #221 West Yan'an Road, Shanghai 20040, China.
¹² Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd.600 Shanghai, China.
¹³ Huashan Hospital, Fudan University, No. 12, WuLuMuQi Middle Road, Shanghai, 200040, China.
¹⁴ Department of Urology, Tenth People's Hospital; Tongji University, Shanghai, China.
¹⁵ Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, 430030, China.
¹⁶ Fudan University Shanghai Cancer Center and Department of Oncology, #270 Dong An Road, Shanghai, 200032, China.
¹⁷ Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
¹⁸ The First Affiliated Hospital of Soochow University, 188 ShiZhi Road, Suzhou, 215006, China.
¹⁹ Peking University People's Hospital, 11 Xizhomen South Street, Beijing, 100044, China.
²⁰ Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 Changlexi Road, Xi'an, 710032 China.
²¹ Department of Urology, 3rd Hospital of Sun Yat-Sen University, Tiehe Road 600#, Guangzhou, 510630, China.
²² Department of Urology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Road, Haizhu District, Guangzhou, Guangdong, 510282, China.
²³ Department of Urology, Wuhan General Hospital of Guangzhou Military Command, No. 627 Wuluo Rd, Wuhan, Hubei 430070, China.

PMID: 26091007
PMCID: PMC4474838
DOI: 10.1371/journal.pone.0130308

Abstract

Objective: The influence of age on the performance of percent free prostate-specific antigen (%fPSA) in diagnosing prostate cancer (PCa) in East Asians is controversial. We tested the diagnostic performance of %fPSA in a multi-center biopsy cohort in China and identified the proper age-specific cutoff values to avoid unnecessary biopsies.

Methods: Consecutive patients with a prostate-specific antigen (PSA) level of 4.0-10.0 ng/ml or 10.1-20.0 ng/ml who underwent transrectal ultrasound-guided or transperineal prostate biopsy were enrolled from 22 Chinese medical centers from Jan 1, 2010 to Dec 31, 2013. The diagnostic accuracy of PSA and %fPSA was determined using the area under the receiver operating characteristic (ROC) curve (AUC). Age-specific cutoff values were calculated using ROC curve analysis.

Results: The median %fPSA was much lower in younger patients compared with older patients with a PSA level of 4.0-10.0 ng/ml or 10.1-20.0 ng/ml. The AUC of %fPSA was higher than PSA only in older patients. In patients aged 50 to 59 years, %fPSA failed to improve the diagnosis compared with PSA in these two PSA ranges. Age-specific cutoff values were 24%, 27% and 32% for patients aged 60-69, 70-79 and ≥80 years, respectively, to reduce unnecessary biopsies in men with PSA levels of 4.0-10.0 ng/ml to detect 90% of all PCa.

Conclusions: The effectiveness of %fPSA is correlated with age in the Chinese population. Age-specific cutoff values would help avoid unnecessary biopsies in the Chinese population.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

**Fig 1. ROC curves of %fPSA and PSA for any PCa.**
ROC curves of %fPSA and PSA in predicting any prostate cancer for patients aged (A) 50–59 years; (B) 60–69 years; (C) 70–79 years; and (D) 80–89 years with a PSA level of 4.0–10.0 ng/ml.

**Fig 2. ROC curves of %fPSA and PSA for high-grade PCa.**
ROC curves of %fPSA and PSA in predicting high-grade prostate cancer for patients aged (A) 50–59 years; (B) 60–69 years; (C) 70–79 years; and (D) 80–89 years with a PSA level of 4.0–10.0 ng/ml.

See this image and copyright information in PMC

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Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml

Collaborators

Affiliations

Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Miscellaneous