Percent free prostate-specific antigen does not improve the effectiveness of prostate cancer detection in Chinese men with a prostate-specific antigen of 2.5–20.0 ng/ml: a multicenter study

Abstract

The prostate-specific antigen (PSA) "gray zone" in Chinese men is likely higher than the traditional value (2.5-10.0 ng/ml) since the incidence of prostate cancer in Chinese men is relative low. The utility of percent free PSA in predicting prostate cancer is based on Western populations and may introduce sizable bias when applied to a Chinese cohort. We assessed the efficacy of percent free PSA in predicting prostate cancer in Chinese men with a PSA of 2.5-10.0 and 10.1-20.0 ng/ml. A total of 558 men with a PSA of 2.5-20.0 ng/ml who had undergone prostatic biopsy to detect prostate cancer from two Chinese centers were included. The rates of prostate cancer in different percent free PSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate and compare the efficiency of PSA and percent free PSA in the diagnosis of prostate cancer. The areas under ROC (AUCs) for percent free PSA for predicting prostate cancer were not higher than those for PSA, although prostate cancer detection rates increased with decreased percent free PSA in men with a PSA of 2.5-10.0, 10.1-20.0, and 2.5-20.0 ng/ml. Similarly, for men aged <70 and ≥ 70 years and with prostate volume <40 and ≥ 40 ml, AUCs showed percent free PSA was not better than PSA in predicting prostate cancer. By analyzing multicenter data, we first found that percent free PSA does not improve detection of prostate cancer in Chinese men with a PSA of 2.5-10.0 or 10.1-20.0 ng/ml.

Percentage of free prostate‐specific antigen (PSA) is a useful method in deciding to perform prostate biopsy with higher core numbers in patients with low PSA cut‐off values

“…Consistent with this finding, Catalona et al [3] reported median tPSA values of 5.6 ng/mL and 5.9 ng/mL in their benign and cancer groups, respectively; these values were not significantly different. Similar findings were reported in a study of Chinese men with tPSA levels of 2.5–20 ng/mL [16]. The men were divided into two groups based on their tPSA value: 2.5–10 ng/mL and 10.1–20 ng/mL.…”

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

“…Although studies indicated a similar effectiveness of %fPSA in Chinese and other East Asian populations compared with the Western population, 15 16 recent reports illustrated a limited improvement of %fPSA in younger Koreans with a PSA of 4.0–10.0 ng ml −1 and in Chinese men with PSA 2.5–10 ng ml −1 and 10.1–20.0 ng ml −1 . 11 17 In our data set, the AUC of %fPSA was also close to that of PSA in the whole cohort but significantly higher than PSA in the older subgroup. However, there were only 274 patients with a PSA of 2.5–10.0 ng ml −1 and 284 patients with a PSA of 10.1–20.0 ng ml −1 in that study.…”

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

“…The diagnostic efficacy of %fPSA is weaker in Chinese and Korean populations than Western populations [ 11 , 12 ]. Some studies excluded %fPSA from multivariable nomograms for PCa prediction in the Chinese population [ 13 ].…”