| Prostate Cancer(PCa) is the second most common diagnosed malignancy and the leading cause of death from malignancy in male [1]。The incidence of PCa in Asian countries like China is much lower, however, it is increasing at a very fast speed, with changes in lifestyle and aging of the population. The annual increase rate of PCa is higher than any other common diagnosed malignancies, according to the annual report of malignancy in China [3,4]. Furthermore, PCa patients in China are usually diagnosed at a later stage. There are a high rate of patients diagnosed with locally advanced or metastatic PCa.The current main strategy to diagnose prostate cancer is prostate biopsy. However, prostate biopsy may lead to the harms of the the patients and it is vital question about when to take a biopsy. There has been a lot of studies that investigated the proper indication for prostate biopsy, nevertheless, there is not a systematic report about how prostate biopsies were performed in China.The most widely-applied biomarker for prostate cancer diagnosis is Prostate-specific antigen(PSA) and the most widely-used examination is digital rectal examination(DRE). Although a number of biomarkers and novel imaging examinations were emerging, these tests were still in early stages of development. PSA remains the most widely-used clinical applicable tests for PCa diagnosis. Since PSA was discovered and validated in western population, the diagnostic strategy of using PSA is mainly based on the results of studies in Western populations. Although there were scattered studies reporting differences in the application of PSA in Asian population, there were not large scale of reports about the detection rate of PSA in Chinese populations. %fPSA is a derivative biomarker of PSA. It is calculated by the percentage of free PSA to the total PSA level. %fPSA were studied in Chinese population, however, these studies were performed in a small number of patients.With the cooperation of Chinese prostate cancer consortium hospitals, the patients underwent prostate biopsy from January 2010 to December 2013 from 33 hospitals were included in this study. Statistical analysis were performed to illustrate the characteristics of all involved patients. Locally weighted scatter plots were applied to show the relationship of PSA and PCa detection rate at each PSA level. receiver operating characteristic(ROC) curve analysis were applied for the analysis of the effectiveness of %fPSA and adding %fPSA to PSA.First, we identified that the medians age of patients underwent prostate biopsy was 70 years old and was much higher than that of reports in Western population. There are 65.3% patients who underwent biopsy had a PSA level of over 10 ng/ml. The Gleason score of diagnosed PCa patients were higher, with 78.8% of PCa patients diagnosed with Gleason score ≥7(high –grade prostate cancer, HGPCa).Second, we illustrated the relationship between PSA and PCa detection rate in Chinese population. We found the detection rate of PCa in men with a PSA of 4.0 – 10.0 ng/ml was 25.6% and 34.8% for men with a PSA of 10.0-20.0 ng/ml. The PSA-PCa detection rate curve was quite flat. The detection rate curve in Chinese was much lower than that of Western population.Finally, we proposed that using %fPSA was limited in patients in certain age range and it was not applicable in men aged less than 60 years old. %fPSA could not help the diagnosis of men with aged less than 60 years old. Further, we found that %fPSA was applicable for more patients. We confirmed that %fPSA is applicable in men with a PSA level of 10.0 – 20.0 ng/ml. The diagnostic performance is better in this ranges than the PSA 4.0-10.0 ng/ml range. |
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