Abstract
BackgroundProstate-specific antigen (PSA) screening is growing in popularity in China, but its impact on biopsy characteristics and outcomes are poorly understood.ObjectiveOur objective was to characterize prostate biopsy outcomes and trends in Chinese men over a 10-year period, since the increasing use of PSA tests.MethodsAll men (n = 1,650) who underwent prostate biopsy for PCa at Huashan Hospital, Shanghai, China from 2003–2011 were evaluated. Demographic and clinical information was collected for each patient, including age, digital rectal examination (DRE), transrectal ultrasound (prostate volume and nodule), total prostate-specific antigen (tPSA) levels and free PSA ratio (fPSA/tPSA) prior to biopsy. Prostate biopsy was performed using six cores before October 2007 or ten cores thereafter. Logistic regression and multivariate analysis were used to evaluate our data.ResultsThe overall positive rate of prostate biopsy for PCa was 47% and the rate decreased significantly over the years from 74% in 2003 to 33% in 2011 (P-trend = 0.004) . Age at diagnosis was slightly increased (P-trend = 0.04) while fPSA/tPSA was significantly decreased (P-trend = 1.11×10-5). A statistically significant trend was not observed for tPSA levels, prostate volume, or proportion of positive nodule. The model including multiple demographic and clinical variables (i.e., age, DRE, tPSA, fPSA/tPSA and transrectal ultrasound results) (AUC = 0.93) statistically outperformed models that included only PSA (AUC = 0.85) or fPSA/tPSA (AUC = 0.66) to predict PCa risks (P<0.05). Similar results were observed in a subgroup of men whose tPSA levels were lower than 20 ng/mL (AUC = 0.87, vs. AUC of tPSA = 0.62, P<0.05).ConclusionsDetection rates of PCa and high-grade PCa among men that underwent prostate biopsy at the institution has decreased significantly in the past 10 years, likely due to increasing use of PSA tests. Predictive performance of demographic and clinical variables of PCa was excellent. These variables should be used in clinics to determine the need for prostate biopsy.
Highlights
In the past two decades, prostate cancer (PCa) has become one of the most prevalent malignant tumors in western countries, and is the second leading cause of cancer death in men [1]
Predictive performance of demographic and clinical variables of PCa was excellent. These variables should be used in clinics to determine the need for prostate biopsy
Blood samples were collected on the day before biopsy and prior to any manipulations (e.g. digital rectal exam (DRE), transrectal ultrasound) that may have caused a transient increase of biomarkers
Summary
In the past two decades, prostate cancer (PCa) has become one of the most prevalent malignant tumors in western countries, and is the second leading cause of cancer death in men [1]. In China, the incidence of PCa has risen significantly in recent years, prostate-specific antigen (PSA) screening is not common and the majority of Chinese patients are found to have high grade PCa at diagnosis. PSA testing prior to 2007 was only offered to Chinese men highly suspected of having PCa. clinician’s recommended testing if a patient had urinary tract symptoms, a positive digital rectal exam (DRE) or positive transrectal ultrasound. While urology guidelines in China after 2007 recommended annual PSA testing for men over 55 years, testing was selectively provided, most commonly due to lack of insurance coverage. Our objective was to characterize prostate biopsy outcomes and trends in Chinese men over a 10-year period, since the introduction of PSA tests in China. Prostate-specific antigen (PSA) screening is growing in popularity in China, but its impact on biopsy characteristics and outcomes are poorly understood
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