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Volume 17, Issue 6 (November 2015) 17, 1017–1021; 10.4103/1008-682X.150846

Percent free prostate-specific antigen is effective to predict prostate biopsy outcome in Chinese men with prostate-specific antigen between 10.1 and 20.0 ng ml−1

Rui Chen 1,* , Li‑Qun Zhou 2,* , Xiao‑Bing Cai 3,* , Li‑Ping Xie 4 , Yi‑Ran Huang 5 , Da‑Lin He 6 , Xu Gao 1 , Chuan‑Liang Xu 1 , Qiang Ding 7 , Qiang Wei 8 , Chang‑Jun Yin 9 , Shan‑Cheng Ren 1 , Fu‑Bo Wang 1 , Ye Tian 10 , Zhong‑Quan Sun 11 , Qiang Fu 12 , Lu‑Lin Ma 13 , Jun‑Hua Zheng 14 , Zhang‑Qun Ye 15 , Ding‑Wei Ye 16 , Dan‑Feng Xu 17 , Jian‑Quan Hou 18 , Ke‑Xin Xu 19 , Jian‑Lin Yuan 20 , Xin Gao 21 , Chun‑Xiao Liu 22 , Tie‑Jun Pan 23 , Ying‑Hao Sun 1 ; on behalf of Chinese Prostate Cancer Consortium

1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, 200433 China; 2 Department of Urology, Peking University First
Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China; 3 Department of Health Care, PLA Headquarters of the General
Staff Guard Bureau, Beijing 100017, China; 4 Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, China;
5 Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200127, China; 6 Department of Urology, First Affiliated Hospital of Medical School, Xi’an
Jiaotong University, Xi’an 710061, China; 7 Huashan Hospital, Fudan University, Shanghai 200040, China; 8 Department of Urology, West China Hospital, Sichuan University,
Chengdu 610041, Sichuan, China; 9 State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University,
Nanjing 210029, China; 10 Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; 11 Department of Urology, Huadong Hospital,
Fudan University, Shanghai 20040, China; 12 Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China; 13 Department of Urology, Peking
University Third Hospital, Beijing 100083, China; 14 Department of Urology, Tenth People’s Hospital, Tongji University, Shanghai 200072, China; 15 Department of Urology,
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; 16 Fudan University Shanghai Cancer Center, Department
of Oncology, Shanghai 200032, China; 17 Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; 18 The First
Affiliated Hospital of Soochow University, Suzhou 215006, China; 19 Peking University People’s Hospital, Beijing 100044, China; 20 Department of Urology, Xijing Hospital,
The Fourth Military Medical University, Xi’an 710032, China; 21 Department of Urology, Third Hospital of Sun Yat-Sen University, Guangzhou 510630, China; 22 Department
of Urology, Zhujiang Hospital, Southern Medical University, Guangdong 510282, China; 23 Department of Urology, Wuhan General Hospital of Guangzhou Military Command,
Wuhan 430070, China

Correspondence: Prof. YH Sun (sunyh@medmail.com.cn)



Percent free prostatic-specific antigen (%fPSA) has been introduced as a tool to avoid unnecessary biopsies in patients with a serum
PSA level of 4.0–10.0 ng ml−1, however, it remains controversial whether %fPSA is effective in PSA range of 10.1–20.0 ng ml−1 in
both Chinese and Western population. In this study, the diagnostic performance of %fPSA and serum PSA in predicting prostate
cancer (PCa) and high-grade PCa (HGPCa) was analyzed in a multi-center biopsy cohort of 5915 consecutive Chinese patients who
underwent prostate biopsy in 22 hospitals across China from January 1, 2010 to December 31, 2013. The indication for biopsy was
PSA>4.0 ng ml−1 or/and suspicious digital rectal examination. Total and free serum PSA determinations were performed by three
types of electrochemiluminescence immunoassays with recalibration to the World Health Organization standards. The diagnostics
accuracy of PSA, %fPSA and %fPSA in combination with PSA (%fPSA + PSA) was determined by the area under the receivers
operating characteristic curve (AUC). %fPSA was more effective than PSA in men aged ≥60 years old. The AUC was 0.584 and
0.635 in men aged ≥60 years old with a PSA of 4.0–10.0 ng ml−1 and 10.1–20.0 ng ml−1, respectively. The AUC of %fPSA was
superior to that of PSA in predicting HGPCa in patients ≥60 years old in these two PSA range. Our results indicated that %fPSA is
both statistically effective and clinical applicable to predict prostate biopsy outcome in Chinese patients aged ≥60 years old with
a PSA of 4.0–10.0 ng ml−1 and 10.1–20.0 ng ml−1.
Keywords: Chinese population; diagnosis; percent free prostate‑specific antigen; prostate cancer; prostate carcinoma tumor antigen; prostate‑specific antigen

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