Effect of Combination of Total PSA and Free/Total
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RESEARCH ARTICLES
Effect of Combination of Total PSA and Free/Total PSA Ratio on Diagnosis of Prostate Cancer during PSA Screening Test in Chinese Men*
Ling Zhang 1, Guoyi Ji 1, Xingyi Zhang 2, Xiaomeng Li 1, Weihua Wang 1,Hongwen Gao 1, Yuzhuo Pan 1, Kuwahara Masaaki 3, Xuejian Zhao 1**
Abstract: We have investigated the effect of combination of total PSA (TPSA) and free/total PSA (F/T PSA) ratio on diagnosis of prostate cancer (PCa) during PSA screening test in Chinese men. F/T PSA ratio in serum was analyzed prospectively in 187 men when TPSA was in the ranges of 4.0~20.0ng/ml. All of them underwent ultrasound-guided sextant prostate biopsies. Sensitivity, specificity, positive and negative predictive values were calculated by SPSS 10.0 software. Prostate cancer detection rates were 18.1% and 22.5% when TPSA was in the rages of 4.0~10.0ng/ml and >10.0~20.0ng/ml, respectively. F/T PSA ratio was more significant than TPSA in all of the men. When a cut-off value of F/T PSA ratio was set at 0.25, 90.5% and 87.5% of cancers could be detected, while 26.7% and 11.3% unnecessary biopsies could be reduced in the range of 4.0~10.0ng/ml and >10.0~20.0ng/ml respectively. This study reveals that in the cohort of Chinese men in the area of Changchun TPSA is in the range of 4.0~10.0ng/ml, PSA screening candidates with F/T PSA ratio less than 25% should be advised for prostate biopsy. However, for candidates with TPSA in the range of 10.0~20.0ng/ml an optimal cut-off value of F/T PSA ratio need to be established and warrants further investigation.
Key words: prostate cancer; prostate-specific antigen; F/T PSA ratio
Measurement of serum prostate-specific antigen (PSA) is widely used in the early detection of prostate cancer (PCa) [1]. However, PSA can't be regarded as a reliable tumor marker because it lacks sufficient specificity. It only has a cancer detection rate of 25% when total PSA (TPSA) values is in the range of 4.0~10.0ng/ml in a screening population, and a detection rate of >30% when the TPSA is >10.0ng/ml [2]. A recent strategy that enhance the specificity of serum PSA by measuring of free/total PSA (F/T PSA) ratio can well differentiate benign prostate hyperplasia from PCa and improve the specificity of PCa detection in patients with elevated total serum PSA [2-9].
Up to now, reports on mass screening of PCa of China have not been available in the literature. It is important to pursue investigation of PCa in China that is entering an aged country. Since 1998, we have been the first in China conducting the mass screening of PCa by means of TPSA. In the present study, the use of measuring F/T PSA ratio to avoid unnecessary biopsies was evaluated in the cohort of Chinese men with TPSA of 4.0~20.0ng/ml and suitable cut-off value of TPSA for Chinese men was explored.
MATERIALS AND METHODS
1. Subjects
Between April 1998 and April 2003, a project of mass-screening test of PCa was conducted using serum TPSA in the urban area of Changchun, China ......
RESEARCH ARTICLES
Effect of Combination of Total PSA and Free/Total PSA Ratio on Diagnosis of Prostate Cancer during PSA Screening Test in Chinese Men*
Ling Zhang 1, Guoyi Ji 1, Xingyi Zhang 2, Xiaomeng Li 1, Weihua Wang 1,Hongwen Gao 1, Yuzhuo Pan 1, Kuwahara Masaaki 3, Xuejian Zhao 1**
Abstract: We have investigated the effect of combination of total PSA (TPSA) and free/total PSA (F/T PSA) ratio on diagnosis of prostate cancer (PCa) during PSA screening test in Chinese men. F/T PSA ratio in serum was analyzed prospectively in 187 men when TPSA was in the ranges of 4.0~20.0ng/ml. All of them underwent ultrasound-guided sextant prostate biopsies. Sensitivity, specificity, positive and negative predictive values were calculated by SPSS 10.0 software. Prostate cancer detection rates were 18.1% and 22.5% when TPSA was in the rages of 4.0~10.0ng/ml and >10.0~20.0ng/ml, respectively. F/T PSA ratio was more significant than TPSA in all of the men. When a cut-off value of F/T PSA ratio was set at 0.25, 90.5% and 87.5% of cancers could be detected, while 26.7% and 11.3% unnecessary biopsies could be reduced in the range of 4.0~10.0ng/ml and >10.0~20.0ng/ml respectively. This study reveals that in the cohort of Chinese men in the area of Changchun TPSA is in the range of 4.0~10.0ng/ml, PSA screening candidates with F/T PSA ratio less than 25% should be advised for prostate biopsy. However, for candidates with TPSA in the range of 10.0~20.0ng/ml an optimal cut-off value of F/T PSA ratio need to be established and warrants further investigation.
Key words: prostate cancer; prostate-specific antigen; F/T PSA ratio
Measurement of serum prostate-specific antigen (PSA) is widely used in the early detection of prostate cancer (PCa) [1]. However, PSA can't be regarded as a reliable tumor marker because it lacks sufficient specificity. It only has a cancer detection rate of 25% when total PSA (TPSA) values is in the range of 4.0~10.0ng/ml in a screening population, and a detection rate of >30% when the TPSA is >10.0ng/ml [2]. A recent strategy that enhance the specificity of serum PSA by measuring of free/total PSA (F/T PSA) ratio can well differentiate benign prostate hyperplasia from PCa and improve the specificity of PCa detection in patients with elevated total serum PSA [2-9].
Up to now, reports on mass screening of PCa of China have not been available in the literature. It is important to pursue investigation of PCa in China that is entering an aged country. Since 1998, we have been the first in China conducting the mass screening of PCa by means of TPSA. In the present study, the use of measuring F/T PSA ratio to avoid unnecessary biopsies was evaluated in the cohort of Chinese men with TPSA of 4.0~20.0ng/ml and suitable cut-off value of TPSA for Chinese men was explored.
MATERIALS AND METHODS
1. Subjects
Between April 1998 and April 2003, a project of mass-screening test of PCa was conducted using serum TPSA in the urban area of Changchun, China ......
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