Chen Rui, Huang Yiran, Cai Xiaobing, Xie Liping, He Dalin, Zhou Liqun, Xu Chuanliang, Gao Xu, Ren Shancheng, Wang Fubo, Ma Lulin, Wei Qiang, Yin Changjun, Tian Ye, Sun Zhongquan, Fu Qiang, Ding Qiang, Zheng Junhua, Ye Zhangqun, Ye Dingwei, Xu Danfeng, Hou Jianquan, Xu Kexin, Yuan Jianlin, Gao Xin, Liu Chunxiao, Pan Tiejun, Sun Yinghao
Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
Renji Hospital, Shanghai Jiao Tong University, School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.
PLoS One. 2015 Jun 19;10(6):e0130308. doi: 10.1371/journal.pone.0130308. eCollection 2015.
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.
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.
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.
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.
年龄对游离前列腺特异性抗原百分比（%fPSA）诊断东亚人前列腺癌（PCa）的性能影响存在争议。我们在中国的一个多中心活检队列中测试了%fPSA的诊断性能，并确定了特定年龄的合适临界值以避免不必要的活检。
从2010年1月1日至2013年12月31日，连续纳入来自22个中国医疗中心的前列腺特异性抗原（PSA）水平为4.0 - 10.0 ng/ml或10.1 - 20.0 ng/ml且接受经直肠超声引导或经会阴前列腺活检的患者。使用受试者操作特征（ROC）曲线下面积（AUC）确定PSA和%fPSA的诊断准确性。通过ROC曲线分析计算特定年龄的临界值。
在PSA水平为4.0 - 10.0 ng/ml或10.1 - 20.0 ng/ml的患者中，年轻患者的%fPSA中位数远低于老年患者。仅在老年患者中，%fPSA的AUC高于PSA。在50至59岁的患者中，在这两个PSA范围内，与PSA相比，%fPSA未能改善诊断。对于PSA水平为4.0 - 10.0 ng/ml的60 - 69岁、70 - 79岁和≥80岁患者，特定年龄的临界值分别为24%、27%和32%，以检测90%的所有PCa，从而减少不必要的活检。
在中国人群中，%fPSA的有效性与年龄相关。特定年龄的临界值有助于在中国人群中避免不必要的活检。
