PLoS ONE (Jan 2015)

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.

  • Rui Chen,
  • Yiran Huang,
  • Xiaobing Cai,
  • Liping Xie,
  • Dalin He,
  • Liqun Zhou,
  • Chuanliang Xu,
  • Xu Gao,
  • Shancheng Ren,
  • Fubo Wang,
  • Lulin Ma,
  • Qiang Wei,
  • Changjun Yin,
  • Ye Tian,
  • Zhongquan Sun,
  • Qiang Fu,
  • Qiang Ding,
  • Junhua Zheng,
  • Zhangqun Ye,
  • Dingwei Ye,
  • Danfeng Xu,
  • Jianquan Hou,
  • Kexin Xu,
  • Jianlin Yuan,
  • Xin Gao,
  • Chunxiao Liu,
  • Tiejun Pan,
  • Yinghao Sun,
  • Chinese Prostate Cancer Consortium

DOI
https://doi.org/10.1371/journal.pone.0130308
Journal volume & issue
Vol. 10, no. 6
p. e0130308

Abstract

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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.