title: Outcomes and trends of prostate biopsy for prostate cancer in Chinese men from 2003 to 2011.
abstract: BACKGROUND
  Prostate-specific antigen (PSA) screening is growing in popularity in China, but its impact on biopsy characteristics and outcomes are poorly understood.
  
  
  OBJECTIVE
  Our objective was to characterize prostate biopsy outcomes and trends in Chinese men over a 10-year period, since the increasing use of PSA tests.
  
  
  METHODS
  All 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  Detection 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.
authors.affiliation: Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Na
authors.forename: Haowen
authors.initials: H
authors.lastname: Jiang
authors.forename: Seong-Tae
authors.initials: ST
authors.lastname: Kim
authors.forename: Yishuo
authors.initials: Y
authors.lastname: Wu
authors.forename: Shijun
authors.initials: S
authors.lastname: Tong
authors.forename: Limin
authors.initials: L
authors.lastname: Zhang
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xu
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001706:Biopsy; D002681:China; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen