title: Transition zone PSA density improves the prostate cancer detection rate both in PSA 4.0-10.0 and 10.1-20.0 ng/ml in Chinese men.
abstract: OBJECTIVE
  We hypothesized the prostate-specific antigen (PSA) "grey zone" in Chinese men was higher than the traditional value (4.0-10.0 ng/ml) since incidence of prostate cancer (CaP) in Chinese men was relative low. We then assessed the efficiencies of transition zone PSA density (TZPSAD) in the diagnosis of CaP in Chinese men with a PSA of both 4.0-10.0 and 10.1-20.0 ng/ml.
  
  
  METHODS
  Men had a prostatic biopsy for detecting CaP from November 1999 to August 2009 were retrospectively retrieved from our computer center. Those had a document of transrectal ultrasound transition zone measurement with a PSA of 4.0-20.0 ng/ml were included. Receiver-operating characteristic (ROC) curve was used to analyze the efficiencies of PSA and TZPSAD in the diagnosis of CaP.
  
  
  RESULTS
  A total of 189 men were included in the study. Of these men, 78 and 111 had a PSA of 4.0-10.0 and 10.1-20.0 ng/ml, respectively. The rate of CaP in men with a PSA of 4.0-10.0 ng/ml was not statistically significantly different compared with those with a PSA of 10.1-20.0 ng/ml (20.5% vs. 21.6%, P = 0.854). The areas under the ROC curve (AUCs) in diagnosis of CaP for PSA and TZPSAD were 0.569 and 0.702 in men with a PSA of 4.0-10.0 ng/ml and 0.463 and 0.730 in men with a PSA of 10.1-20.0 ng/ml, respectively. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 4.0-10.0 ng/ml was 0.370 ng/ml/ml, the sensitivity of which equaled 68.8%, specificity 72.6%. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 10.1-20.0 ng/ml was 0.500 ng/ml/ml. Its sensitivity equaled 70.8%, specificity 70.1%.
  
  
  CONCLUSIONS
  Using TZPSAD can improve the efficiency of PSA in diagnosis of CaP and decreases the unnecessary prostatic biopsy in men with a PSA of both 4.0-10.0 and 10.1-20.0 ng/ml in Chinese men.
authors.affiliation: Department of Urology, Guangzhou First Municipal People's Hospital, Guangzhou Medical College, Guangdong, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Tang
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: Keji
authors.initials: K
authors.lastname: Xie
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Deng
authors.forename: Jingao
authors.initials: J
authors.lastname: Fu
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Wenjun
authors.initials: W
authors.lastname: Yang
mesh_terms: D000368:Aged; D044466:Asian People; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen