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Performance of serum prostate‐specific antigen isoform [‐2]proPSA (p2PSA) and the prostate health index (PHI) in a Chinese hospital‐based biopsy population
Author(s) -
Na Rong,
Ye Dingwei,
Liu Fang,
Chen Haitao,
Qi Jun,
Wu Yishuo,
Zhang Guiming,
Wang Meilin,
Wang Wenying,
Sun Jielin,
Yu Guopeng,
Zhu Yao,
Ren Shancheng,
Zheng S. Lilly,
Jiang Haowen,
Sun Yinghao,
Ding Qiang,
Xu Jianfeng
Publication year - 2014
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.22876
Subject(s) - medicine , prostate cancer , prostate biopsy , biopsy , urology , receiver operating characteristic , prostate , prostate specific antigen , area under the curve , cancer
BACKGROUND The use of serum [‐2]proPSA (p2PSA) and its derivative, the prostate health index (PHI), in detecting prostate cancer (PCa) have been consistently shown to have better performance than total prostate‐specific antigen (tPSA) in discriminating biopsy outcomes in western countries. However, little is known about their performance in Chinese men. Our objective is to test the performance of p2PSA and PHI and their added value to tPSA in discriminating biopsy outcomes in Chinese men. METHODS Consecutive patients who underwent prostate biopsy in three tertiary hospitals in Shanghai, China during 2012–2013 were recruited. Serum tPSA, free PSA (fPSA), and p2PSA were measured centrally using Beckman Coulter's DxI 800 Immunoassay System. The primary outcome is PCa and the secondary outcome is high‐grade PCa (Gleason Score of 4 + 3 or worse). Discriminative performance was assessed using the area under the receiver operating characteristic curve (AUC), detection rate and Decision Curve Analysis (DCA). RESULTS Among 636 patients who underwent prostate biopsy, PHI was a significant predictor of biopsy outcomes, independent of other clinical variables. The AUC in discriminating PCa from non‐PCa was consistently higher for PHI than tPSA in the entire cohort (0.88 vs. 0.81) as well as in patients with tPSA at 2–10 ng/ml (0.73 vs. 0.53), at 10.1–20 ng/ml (0.81 vs. 0.58), and at tPSA >20 ng/ml (0.90 vs. 0.80). The differences were statistically significant in all comparisons, P < 0.01. To detect 90% of all PCa in the cohort, 362 and 457 patients would need to be biopsied based on PHI and tPSA cutoff, respectively, a 21% reduction for PHI. Similar results were found for discriminating high‐grade PCa. CONCLUSIONS PHI provides added value over tPSA in discriminating PCa and high‐grade PCa in patients who underwent prostate biopsy in China. Prostate 74:1569–1575, 2014 . © 2014 Wiley Periodicals, Inc.