Prostate Specific Antigen and Prostate Cancer in Chinese Men Undergoing Initial Prostate Biopsies Compared with Western Cohorts.
We determined the characteristics of Chinese men undergoing initial prostate biopsy and evaluated the relationship between prostate specific antigen levels and prostate cancer/high grade prostate cancer detection in a large Chinese multicenter cohort.



This retrospective study included 13,904 urology outpatients who had undergone biopsy for the indications of prostate specific antigen greater than 4.0 ng/ml or prostate specific antigen less than 4.0 ng/ml but with abnormal digital rectal examination results. The prostate specific antigen measurements were performed in accordance with the standard procedures at the respective institutions. The type of assay used was documented and recalibrated to the WHO standard.



The incidence of prostate cancer and high grade prostate cancer was lower in the Chinese cohort than the Western cohorts at any given prostate specific antigen level. Around 25% of patients with a prostate specific antigen of 4.0 to 10.0 ng/ml were found to have prostate cancer compared to approximately 40% in U.S. clinical practice. Moreover, the risk curves were generally flatter than those of the Western cohorts, that is risk did not increase as rapidly with higher prostate specific antigen.



The relationship between prostate specific antigen and prostate cancer risk differs importantly between Chinese and Western populations, with an overall lower risk in the Chinese cohort. Further research should explore whether environmental or genetic differences explain these findings or whether they result from unmeasured differences in screening or benign prostate disease. Caution is required for the implementation of prostate cancer clinical decision rules or prediction models for men in China or other Asian countries with similar genetic and environmental backgrounds.
Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China.
Rui
R
Chen
Memorial Sloan Kettering Cancer Center, New York, New York.
Daniel D
DD
Sjoberg
Department of Urology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Yiran
Y
Huang
Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Liping
L
Xie
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Liqun
L
Zhou
Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.
Dalin
D
He
Memorial Sloan Kettering Cancer Center, New York, New York.
Andrew J
AJ
Vickers
Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: sunyhsmmu@126.com.
Yinghao
Y
Sun
D000367:Age Factors; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001707:Biopsy, Needle; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D019049:Developed Countries; D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000208:ethnology / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D044465:White People / Q000706:statistics & numerical data
D017430:Prostate-Specific Antigen
China; biopsy; early detection of cancer; prostate-specific antigen; prostatic neoplasms