Abstract
ObjectiveThe 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.MethodsConsecutive 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.ResultsThe 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.ConclusionsThe effectiveness of %fPSA is correlated with age in the Chinese population. Age-specific cutoff values would help avoid unnecessary biopsies in the Chinese population.
Highlights
Prostate cancer (PCa) is the second most common diagnosed malignancy in males globally [1]
The median %fPSA was much lower in younger patients compared with older patients with a prostate-specific antigen (PSA) level of 4.0–10.0 ng/ml or 10.1–20.0 ng/ml
The areas under the ROC curves (AUC) of %fPSA was higher than PSA only in older patients
Summary
Prostate cancer (PCa) is the second most common diagnosed malignancy in males globally [1]. Percent free PSA (%fPSA) is recommended to reduce unnecessary biopsies for men with serum prostate-specific antigen (PSA) levels of 4.0–10.0 ng/ml in white and black populations [5, 6]. Oesterling et al [7] established age-specific reference ranges for serum PSA levels in Caucasians to improve its sensitivity in younger patients and to increase its specificity in older patients. Our previous studies found that age-specific reference ranges of PSA are lower in Chinese populations [9]. Catalona et al [5] observed different levels of %fPSA in different age groups. These age-specific cutoff values were not recommended because the
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