title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Chen
authors.affiliation: Renji Hospital, Shanghai Jiao Tong University, School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.
authors.forename: Yiran
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Health Care, PLA Headquarters of the General Staff Guard Bureau, Beijing 100017, China.
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277 west Yanta Road, Xi'an 710061, China.
authors.forename: Dalin
authors.initials: D
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer center, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Liqun
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
authors.forename: Chuanliang
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
authors.forename: Shancheng
authors.initials: S
authors.lastname: Ren
authors.affiliation: Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
authors.forename: Fubo
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Urology, Peking University Third Hospital, No 49,North Garden Road, Haidian Dist, Beijing, China.
authors.forename: Lulin
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Guoxuexiang 37# 610041, Chengdu Sichuan, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
authors.affiliation: State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; No.300 Guangzhou Road, Nanjing, Jiangsu Province, China; Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; No.300 Guangzhou Road, Nanjing, Jiangsu Province, China.
authors.forename: Changjun
authors.initials: C
authors.lastname: Yin
authors.affiliation: Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Urology, Huadong Hospital, Fudan University, #221 West Yan'an Road, Shanghai 20040, China.
authors.forename: Zhongquan
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd.600 Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.affiliation: Huashan Hospital, Fudan University, No. 12, WuLuMuQi Middle Road, Shanghai, 200040, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
authors.affiliation: Department of Urology, Tenth People's Hospital; Tongji University, Shanghai, China.
authors.forename: Junhua
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, 430030, China.
authors.forename: Zhangqun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Fudan University Shanghai Cancer Center and Department of Oncology, #270 Dong An Road, Shanghai, 200032, China.
authors.forename: Dingwei
authors.initials: D
authors.lastname: Ye
authors.affiliation: Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Danfeng
authors.initials: D
authors.lastname: Xu
authors.affiliation: The First Affiliated Hospital of Soochow University, 188 ShiZhi Road, Suzhou, 215006, China.
authors.forename: Jianquan
authors.initials: J
authors.lastname: Hou
authors.affiliation: Peking University People's Hospital, 11 Xizhomen South Street, Beijing, 100044, China.
authors.forename: Kexin
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 Changlexi Road, Xi'an, 710032 China.
authors.forename: Jianlin
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Department of Urology, 3rd Hospital of Sun Yat-Sen University, Tiehe Road 600#, Guangzhou, 510630, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Urology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Road, Haizhu District, Guangzhou, Guangdong, 510282, China.
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Urology, Wuhan General Hospital of Guangzhou Military Command, No. 627 Wuluo Rd, Wuhan, Hubei 430070, China.
authors.forename: Tiejun
authors.initials: T
authors.lastname: Pan
authors.affiliation: Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D002681:China; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen