Percent free prostate-specific antigen for prostate cancer diagnosis in Chinese men with a PSA of 4.0-10.0 ng/mL: results from the Chinese Prostate Cancer Consortium

Asian Journal of Urology, 2015, 2 (2): 107-113 doi:

Original Article

Percent free prostate-specific antigen for prostate cancer diagnosis in Chinese men with a PSA of 4.0-10.0 ng/mL: results from the Chinese Prostate Cancer Consortium

Rui Chen, Liping Xie, Xiaobing Cai, Yiran Huang, Liqun Zhou, Lulin Ma, Xu Gao, Chuanliang Xu, Shancheng Ren, Pengfei Shao, Danfeng Xu, Kexin Xu, Zhangqun Ye, Chunxiao Liu, Dingwei Ye, Li Lu, Qiang Fu, Jianquan Hou, Jianlin Yuan, Dalin He, Tie Zhou, Fubo Wang, Biming He, Yinghao Sun

1. Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China;
2. Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China;
3. Department of Health Care, PLA Headquarters of the General Staff Guard Bureau, Beijing, China;
4. Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China;
5. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer; Center, Beijing, China;
6. Department of Urology, Peking University Third Hospital, Beijing, China;
7. State Key Laboratory of Reproductive Medicine,. Department of Urology, The First Affiliated Hospital of Nanjing Medical;University, Nanjing, China;
8. Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China;
9. Peking University People's Hospital, Beijing, China;
10. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan,;China;
11. Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China;
12. Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai, China;
13. Department of Urology, 3rd Hospital of Sun Yat-Sen University, Guangzhou, China;
14. Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China;
15. The First Affiliated Hospital of Soochow University, Suzhou, China;
16. Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China;
17. Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China

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Abstract Objective: To test the diagnostic performance of percent free prostate-specific antigen (%fPSA) in predicting any prostate cancer (PCa) and high-grade prostate cancer (HGPCa) in a retrospective multi-center biopsy cohort with a PSA level of 4.0-10.0 ng/mL in China. Methods: Consecutive patients with a PSA of 4.0-10.0 ng/mL who underwent transrectal ultrasound-guided biopsy were enrolled at 16 Chinese medical centers from January 1st, 2010 to December 31st, 2013. Total and free serum PSA determinations were performed using three types of electro-chemiluminescence immunoassays recalibrated to the World Health Organization (WHO) standard. The diagnostic accuracy of PSA, %fPSA and %fPSA in combination with PSA (%fPSA+PSA) was determined using the area under the receiver operating characteristic (ROC) curve (AUC). Resultsa: A total of 2,310 consecutive men with PSA levels between 4.0 and 10.0 ng/mL were included, and the detection rate of PCa was 25.1%. The AUC of %fPSA and %fPSA+PSA in predicting any PCa was superior to PSA alone in men aged ≥60 years (0.623 vs. 0.534, p< 0.0001) but not in men aged 40-59 years (0.517 vs. 0.518, p= 0.939). Similar result was yield in predicting HGPCa. Conclusion: In a clinical setting of Chinese men with 4.0-10.0 ng/mL PSA undergoing initial prostate biopsy, adding %fPSA to PSA can moderately improve the diagnostic accuracy for any PCa and HGPCa compared with PSA alone in patients ≥60 but not in patients aged 40-59 years.

Key words： Prostate cancer Diagnosis Prostate-specific Antigen Percent free PSA Chinese population ROC curve

Published: 30 April 2015

Fund:This work was supported by the Chinese Prostate Cancer Consortium, Program for Changjiang Scholars, the University Innovative Research Team of the Ministry of Education of China (NO.IRT1111, Yinghao Sun) and the National Basic Research Program of China (2012CB518300, 2012CB518306, Yinghao Sun).

Corresponding Authors: Yinghao Sun E-mail: sunyh@medmail.com.cn

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	Rui Chen
	Liping Xie
	Xiaobing Cai
	Yiran Huang
	Liqun Zhou
	Lulin Ma
	Xu Gao
	Chuanliang Xu
	Shancheng Ren
	Pengfei Shao
	Danfeng Xu
	Kexin Xu
	Zhangqun Ye
	Chunxiao Liu
	Dingwei Ye
	Li Lu
	Qiang Fu
	Jianquan Hou
	Jianlin Yuan
	Dalin He
	Tie Zhou
	Fubo Wang
	Biming He
	Yinghao Sun

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Cite this article:

Rui Chen,Liping Xie,Xiaobing Cai, et al. Percent free prostate-specific antigen for prostate cancer diagnosis in Chinese men with a PSA of 4.0-10.0 ng/mL: results from the Chinese Prostate Cancer Consortium[J]. Asian Journal of Urology, 2015, 2(2): 107-113.

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http://www.ajurology.com/EN/ OR http://www.ajurology.com/EN/Y2015/V2/I2/107

[1]	Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013; 63: 11-30.
[2]	Center MM, Jemal A, Lortet-Tieulent J, Ward E, Ferlay J, Brawley O, et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61: 1079-92.
[3]	Zhao P, Chen W. Annual report of Malignancy in China 2004. Beijing: Peking Union Medical College Press, 2008.
[4]	Hao J, Chen WQ. Chinese Cancer Registry Annual Report 2012. Beijing: China Military Medical Science Press, 2013.
[5]	Christensson A, Bjork T, Nilsson O, Dahlen U, Matikainen MT, Cockett AT, et al. Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol 1993; 150: 100-5.
[6]	Catalona WJ, Smith DS, Wolfert RL, Wang TJ, Rittenhouse HG, Ratliff TL, et al. Evaluation of percentage of free serum prostatespecific antigen to improve specificity of prostate cancer screening. JAMA 1995; 1214-20.
[7]	Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998;279: 1542-7.
[8]	Lee R, Localio AR, Armstrong K, Malkowicz SB, Schwartz JS; Free PSA Study Group. A meta-analysis of the performance characteristics of the free prostate-specific antigen test. Urology 2006; 67: 762-8.
[9]	Ferlay J SI, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available online at: http://globocan.iarc.fr, accessed on 2014/08/28.
[10]	Liu ZY, Sun YH, Xu CL, Gao X, Zhang LM, Ren SC. Age-specific PSA reference ranges in Chinese men without prostate cancer. Asian J Androl 2009; 11: 100-3.
[11]	Oesterling JE, Kumamoto Y, Tsukamoto T, Girman CJ, Guess HA, Masumori N, et al. Serum prostate-specific antigen in a communitybased population of healthy Japanese men: lower values than for similarly aged white men. Br J Urol 1995; 75: 347-53.
[12]	Huang M, Lin Y, Xu A, Uhlman M, Deng X, Lin X, et al. 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. Med Oncol 2014; 31: 925.
[13]	Wang Y, Sun G, Pan JG, Guo ZJ, Li T. Performance of tPSA and f/tPSA for prostate cancer in Chinese. A systematic review and metaanalysis. Prostate Cancer Prostatic Dis 2006; 9: 374-8.
[14]	Gelmann EP, Chia D, Pinsky PF, Andriole GL, Crawford ED, Reding D, et al. Relationship of demographic and clinical factors to free and total prostate-specific antigen. Urology 2001; 58: 561-6.
[15]	Suzuki H, Komiya A, Kamiya N, Imamoto T, Kawamura K, Miura J, et al. Development of a nomogram to predict probability of positive initial prostate biopsy among Japanese patients. Urology 2006; 67: 131-6.
[16]	Jeong IG, Lee KH; Korean Urological Oncologic Society Prostate Cancer Study Group. Percent free prostate specific antigen does not enhance the specificity of total prostate specific antigen for the detection of prostate cancer in Korean men 50 to 65 years old: a prospective multicenter study. J Urol 2008; 179: 111-6.
[17]	Omar J, Jaafar Z, Abdullah MR. A pilot study on percent free prostate specific antigen as an additional tool in prostate cancer screening. Malays J Med Sci 2009; 16: 44-7.
[18]	Oesterling JE, Jacobsen SJ, Klee GG, Pettersson K, Piironen T, Abrahamsson PA, et al. Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios. J Urol 1995; 154: 1090-5.
[19]	Kalish LA, McKinlay JB. Serum prostate-specific antigen levels (PSA) in men without clinical evidence of prostate cancer: agespecific reference ranges for total PSA, free PSA, and percent free PSA. Urology 1999; 54: 1022-7.
[20]	Catalona WJ, Partin AW, Slawin KM, Naughton CK, Brawer MK, Flanigan RC, et al. Percentage of free PSA in black versus white men for detection and staging of prostate cancer: a prospective multicenter clinical trial. Urology 2000; 55: 372-6.
[21]	Hara N, Kitamura Y, Saito T, Komatsubara S. Total and free prostatespecific antigen indexes in prostate cancer screening: value and limitation for Japanese populations. Asian J Androl 2006; 8: 429-34.
[22]	Yang WJ, Lee DH, Chung BH, Cho JS, Choi YD, Kim SJ, et al. Detection rate of prostate cancer on biopsy according to serum prostate-specific antigen in Korean men: a multicenter study. Urology 2006; 67: 333-6.
[23]	Thompson IM, Ankerst DP, Chi C, Goodman PJ, Tangen CM, Lucia MS, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2006; 98: 529-34.
[24]	Catalona WJ, Partin AW, Finlay JA, Chan DW, Rittenhouse HG, Wolfert RL, et al. Use of percentage of free prostate-specific antigen to identify men at high risk of prostate cancer when PSA levels are 2.51 to 4 ng/mL and digital rectal examination is not suspicious for prostate cancer: an alternative model. Urology 1999; 54: 220-4.