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Age-Adjusted Reference Values for Prostate Specific Antigen - A Systematic Review and Meta-Analysis. Clin Genitourin Cancer 2021; 20:e114-e125. [PMID: 34969631 DOI: 10.1016/j.clgc.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To systematically evaluates the evidence on ethnic differences in age-adjusted reference values of PSA. MATERIALS AND METHODS In concordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement, a review of English articles using Medline, Embase and Cochrane databases, from inception to December 2019 was conducted. Studies that reported the PSA upper reference value as 95th percentile of the cohort distribution, in healthy men aged 40 to 79, were included. Methodological quality was assessed with a modified version of the Agency for Healthcare Research and Quality checklist for cross-sectional studies. RESULTS Forty-three studies examining 325,514 participants were included in the analysis. These were published between 1993 and 2018. Majority were prospective observational studies and reported the reference values in ten-year age intervals. Only five reports directly compared ethnic differences in PSA values. Due to missing data, six studies were not considered in the quantitative synthesis. For the remainder (37/43), heterogeneity in PSA reference values was considerable (Higgin's index = 99.2%), with age and ethnicity being the sole identified significant contributors. Accordingly, the pooled upper limits for PSA reference values were 2.1, 3.2, 4.9 and 6.5 ng/ml for men in their 40 s, 50 s, 60 s, and 70 s, respectively. CONCLUSION Moderate quality evidence suggest that upper PSA reference limits increased with age and significant ethnic differences were present.
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Zhang K, Bangma CH, Roobol MJ. Prostate cancer screening in Europe and Asia. Asian J Urol 2017; 4:86-95. [PMID: 29264211 PMCID: PMC5717985 DOI: 10.1016/j.ajur.2016.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the second most common cancer among men worldwide and even ranks first in Europe. Although Asia is known as the region with the lowest PCa incidence, it has been rising rapidly over the last 20 years mostly due to the introduction of prostate-specific antigen (PSA) testing. Randomized PCa screening studies in Europe show a mortality reduction in favor of PSA-based screening but coincide with high proportions of unnecessary biopsies, overdiagnosis and subsequent overtreatment. Conclusive data on the value of PSA-based screening and hence the balance between harms and benefits in Asia is still lacking. Because of known racial variations, Asian countries should not directly apply the European screening models. Like in the western world also in Asia, new predictive markers, tools and risk stratification strategies hold great potential to improve the early detection of PCa and to reduce the worldwide existing negative aspects of PSA-based PCa screening.
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Affiliation(s)
| | | | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Fang D, Zhao C, Ren D, Yu W, Wang R, Wang H, Li X, Yin W, Yu X, Yang K, Liu P, Shan G, Li S, He Q, Wang X, Xin Z, Zhou L. Could Magnetic Resonance Imaging Help to Identify the Presence of Prostate Cancer Before Initial Biopsy? The Development of Nomogram Predicting the Outcomes of Prostate Biopsy in the Chinese Population. Ann Surg Oncol 2016; 23:4284-4292. [PMID: 27464612 DOI: 10.1245/s10434-016-5438-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This study was designed to investigate the effectiveness of magnetic resonance imaging (MRI) in diagnosing prostate cancer (PCa) and high-grade prostate cancer (HGPCa) before transrectal ultrasound (TRUS)-guided biopsy. METHODS The clinical data of 894 patients who received TRUS-guided biopsy and prior MRI test from a large Chinese center was reviewed. Based on Prostate Imaging Reporting and Data System (PI-RADS) scoring, all MRIs were re-reviewed and assigned as Grade 0-2 (PI-RADS 1-2; PI-RADS 3; PI-RADS 4-5). We constructed two models both in predicting PCa and HGPCa (Gleason score ≥ 4 + 3): Model 1 with MRI and Model 2 without MRI. Other clinical factors include age, digital rectal examination, PSA, free-PSA, volume, and TRUS. RESULTS PCa and HGPCa were present in 434 (48.5 %) and 218 (24.4 %) patients. An MRI Grade 0, 1, and 2 were assigned in 324 (36.2 %), 193 (21.6 %) and 377 (42.2 %) patients, which was associated with the presence of PCa (p < 0.001) and HGPCa (p < 0.001). Particularly in patients aged ≤55 years, the assignment of MRI Grade 0 was correlated with extremely low rate of PCa (1/27) and no HGPCa. The c-statistic of Model 1 and Model 2 for predicting PCa was 0.875 and 0.841 (Z = 4.2302, p < 0.001), whereas for predicting HGPCa was 0.872 and 0.850 (Z = 3.265, p = 0.001). Model 1 exhibited higher sensitivity and specificity at same cutoffs, and decision-curve analysis also suggested the favorable clinical utility of Model 1. CONCLUSIONS Prostate MRI before biopsy could predict the presence of PCa and HGPCa, especially in younger patients. The incorporation of MRI in nomograms could increase predictive accuracy.
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Affiliation(s)
- Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Chenglin Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Da Ren
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Huihui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Wenshi Yin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xiaoteng Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Pei Liu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Gangzhi Shan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Shuqing Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhongcheng Xin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
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Park HG, Ko OS, Kim YG, Park JK. Efficacy of Repeated Transrectal Prostate Biopsy in Men Younger Than 50 Years With an Elevated Prostate-Specific Antigen Concentration (>3.0 ng/mL): Risks and Benefits Based on Biopsy Results and Follow-up Status. Korean J Urol 2014; 55:249-53. [PMID: 24741413 PMCID: PMC3988435 DOI: 10.4111/kju.2014.55.4.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/14/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Prostate cancer is rare in men younger than 50 years. Digital rectal examination (DRE) and measurement of prostate-specific antigen (PSA) concentrations are standard screening methods for detecting prostate cancer. We retrospectively investigated the risks and benefits of repeated transrectal ultrasonography-guided prostate needle biopsies in relation to the follow-up status of men younger than 50 years with a consistently high PSA concentration (>3.0 ng/mL). MATERIALS AND METHODS During the period from January 2000 through February 2013, we reviewed patient's ages, dates of procedures, DRE results, frequencies of biopsies, results of the biopsies, periods of follow-up, PSA concentrations, and prostate volumes in Chonbuk National University Hospital records. We conducted telephone interviews in patients who did not undergo regular follow-up. RESULTS The mean age of the patients was 44.7 years, and the mean PSA concentration was 8.59 ng/mL (range, 3.04-131 ng/mL) before biopsy. The PSA concentration was significantly different (p<0.001) between the patients with prostate cancer and those with benign prostatic hyperplasia (BPH). Nineteen patients underwent repeated prostate biopsy; however, in only one patient did the pathologic findings indicate a change from BPH to prostate cancer. We identified several complications after transrectal biopsy through an evaluation of follow-up data. CONCLUSIONS All patients with benign prostatic disease based on their first biopsy were shown to have benign disease based on all repeated biopsies (15.83%), except for one patient; however, several complications were noted after biopsy. Therefore, the risks and benefits of repeated biopsy in young patients should be considered because of the low rate of change from benign to malignant disease despite continuously high PSA concentrations (>3.0 ng/mL).
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Affiliation(s)
- Ho Gyun Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Oh Seok Ko
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Gon Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea. ; Institute for Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea. ; Biomedical Research Institute, Chonbuk National University Medical School, Jeonju, Korea. ; Clinical Trial Center of Medical Devices, Chonbuk National University Medical School, Jeonju, Korea
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Mobile application-based Seoul National University Prostate Cancer Risk Calculator: development, validation, and comparative analysis with two Western risk calculators in Korean men. PLoS One 2014; 9:e94441. [PMID: 24710020 PMCID: PMC3978062 DOI: 10.1371/journal.pone.0094441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives We developed a mobile application-based Seoul National University Prostate Cancer Risk Calculator (SNUPC-RC) that predicts the probability of prostate cancer (PC) at the initial prostate biopsy in a Korean cohort. Additionally, the application was validated and subjected to head-to-head comparisons with internet-based Western risk calculators in a validation cohort. Here, we describe its development and validation. Patients and Methods As a retrospective study, consecutive men who underwent initial prostate biopsy with more than 12 cores at a tertiary center were included. In the development stage, 3,482 cases from May 2003 through November 2010 were analyzed. Clinical variables were evaluated, and the final prediction model was developed using the logistic regression model. In the validation stage, 1,112 cases from December 2010 through June 2012 were used. SNUPC-RC was compared with the European Randomized Study of Screening for PC Risk Calculator (ERSPC-RC) and the Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC). The predictive accuracy was assessed using the area under the receiver operating characteristic curve (AUC). The clinical value was evaluated using decision curve analysis. Results PC was diagnosed in 1,240 (35.6%) and 417 (37.5%) men in the development and validation cohorts, respectively. Age, prostate-specific antigen level, prostate size, and abnormality on digital rectal examination or transrectal ultrasonography were significant factors of PC and were included in the final model. The predictive accuracy in the development cohort was 0.786. In the validation cohort, AUC was significantly higher for the SNUPC-RC (0.811) than for ERSPC-RC (0.768, p<0.001) and PCPT-RC (0.704, p<0.001). Decision curve analysis also showed higher net benefits with SNUPC-RC than with the other calculators. Conclusions SNUPC-RC has a higher predictive accuracy and clinical benefit than Western risk calculators. Furthermore, it is easy to use because it is available as a mobile application for smart devices.
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Al-Abdin OZ, Rabah DM, Badr G, Kotb A, Aprikian A. Differences in prostate cancer detection between Canadian and Saudi populations. Braz J Med Biol Res 2013; 46:539-45. [PMID: 23802226 PMCID: PMC3854441 DOI: 10.1590/1414-431x20132757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 03/20/2013] [Indexed: 11/22/2022] Open
Abstract
Few studies have addressed racial differences in prostate cancer (PCa) detection
between Western and Arabian countries, although PCa has a significantly lower
prevalence in Arabic populations compared to Western populations. Therefore, an
explanation of this difference is lacking. Serum prostate-specific antigen (PSA)
is a valuable marker used to select patients who should undergo prostate
biopsies, although the manner in which it is used may require adjustments based
on the ethnic population in question. We investigated racial differences in the
PCa detection rate between Canadian and Saudi populations. A retrospective
analysis was performed of data collected prospectively over 5 consecutive years
in urology clinics at the McGill University Health Center (MUHC) and King Saud
University Hospital (KSUH). Men who had high (>4'ng/mL) or rising PSA levels
and a negative digital rectal examination were eligible. A total of 1403
Canadian and 414 Saudi patients were evaluated for the study; 717 and 158 men,
median age 64 and 68 years, were included in the MUHC and KSUH cohorts,
respectively, P<0.0001). Median serum PSA, prostate volume, and PSA density
values were 6.1'ng/mL, 47.3 g, and 0.12'ng·mL−1·g−1,
respectively, for MUHC patients and 5.2'ng/mL, 64.5'g, and
0.08'ng·mL−1·g−1, respectively, for KSUH patients
(P<0.0001, t-test followed by one-way ANOVA). In addition, the KSUH group had
a significantly lower PCa detection rate among patients younger than 60 years of
age and with PSA values <10'ng/mL.
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Affiliation(s)
- O Z Al-Abdin
- King Saud University, Princess Al-Johara Al-Ibrahim Center for Cancer Research, Prostate Cancer Research Chair, College of Medicine, Prostate Cancer Research Chair, Riyadh, Saudi Arabia
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8
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Jeong CW, Jeong SJ, Hong SK, Lee SB, Ku JH, Byun SS, Jeong H, Kwak C, Kim HH, Lee E, Lee SE. Nomograms to predict the pathological stage of clinically localized prostate cancer in Korean men: comparison with western predictive tools using decision curve analysis. Int J Urol 2012; 19:846-52. [PMID: 22587373 DOI: 10.1111/j.1442-2042.2012.03040.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and evaluate nomograms to predict the pathological stage of clinically localized prostate cancer after radical prostatectomy in Korean men. METHODS We reviewed the medical records of 2041 patients who had clinical stages T1c-T3a prostate cancer and were treated solely with radical prostatectomy at two hospitals. Logistic regressions were carried out to predict organ-confined disease, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis using preoperative variables and resulting nomograms. Internal validations were assessed using the area under the receiver operating characteristic curve and calibration plot, and then external validations were carried out on 129 patients from another hospital. Head-to-head comparisons with 2007 Partin tables and Cancer of the Prostate Risk Assessment score were carried out using the area under the curve and decision curve analysis. RESULTS The significant predictors for organ-confined disease and extraprostatic extension were clinical stage, prostate-specific antigen, Gleason score and a percent positive core of biopsy. Significant predictors for seminal vesicle invasion were prostate-specific antigen, Gleason score and percent positive core, and those for lymph node metastasis were prostate-specific antigen and percent positive core. The area under the curve of established nomograms for organ-confined disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were 0.809, 0.804, 0.889 and 0.838, respectively. The nomograms were well calibrated and externally validated. These nomograms showed significantly higher accuracies and net benefits than two Western tools in Korean men. CONCLUSION This is the first study to have developed and fully validated nomograms to predict the pathological stage of prostate cancer in an Asian population. These nomograms might be more accurate and useful for Korean men than other predictive models developed using Western populations.
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Affiliation(s)
- Chang Wook Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Sutcliffe S, Pakpahan R, Sokoll LJ, Elliott DJ, Nevin RL, Cersovsky SB, Walsh PC, Platz EA. Prostate-specific antigen concentration in young men: new estimates and review of the literature. BJU Int 2012; 110:1627-35. [DOI: 10.1111/j.1464-410x.2012.11111.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Tang P, Du W, Xie K, Fu J, Chen H, Yang W, Moul JW. Characteristics of baseline PSA and PSA velocity in young men without prostate cancer: Racial differences. Prostate 2012; 72:173-80. [PMID: 21538426 DOI: 10.1002/pros.21418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 04/12/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Baseline prostate specific antigen (PSA) and PSA velocity used to stratify subsequent prostate cancer risk in young men may not directly applicable to all populations. We sought to compare the baseline PSA and PSA velocity among ethnic groups. PATIENTS AND METHODS Chinese, African-American (AA), and Caucasian-American (CA) men aged ≤50 years old without prostate cancer were used to identify baseline PSA and PSA velocity. The differences of baseline PSA and PSA velocity between races were assessed. The important cutoffs of baseline PSA and PSA velocity were used to stratify patients among races. RESULTS Four thousand two hundred six Chinese, 997 AA, and 2,030 CA were included. The rates of baseline PSA of ≥1.0, ≥2.5, and ≥4.0 ng/ml was 24.4%, 4.2%, and 2.1% in Chinese, 30.7%, 5.2%, and 1.8% in AA, 29.7%, 5.3%, and 2.8% in CA, respectively. The rates of PSA velocity of ≥0.35, ≥0.75, and ≥1.0 ng/ml/year was 6.0%, 3.1%, and 2.6% in Chinese, 5.3%, 2.3%, and 1.7% in AA, 5.4%, 3.5%, and 3.3% in CA, respectively. Chinese had a lower baseline PSA and higher PSA velocity as compared to AA and CA. Baseline PSA and PSA velocity in AA had no statistical differences as compared to CA. CONCLUSIONS The distributions of baseline PSA and PSA velocity in young men among Chinese, AA, and CA races are different. These characteristics shall be taken into account when using these variables to stratify risk of prostate cancer in young men.
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Affiliation(s)
- Ping Tang
- Department of Urology, Guangzhou First Municipal People's Hospital, Guangzhou Medical College, Guangdong, China
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Park KK, Lee SH, Choi YD, Chung BH. Optimal baseline prostate-specific antigen level to distinguish risk of prostate cancer in healthy men between 40 and 69 years of age. J Korean Med Sci 2012; 27:40-5. [PMID: 22219612 PMCID: PMC3247773 DOI: 10.3346/jkms.2012.27.1.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/01/2011] [Indexed: 02/05/2023] Open
Abstract
The present study evaluated optimal baseline prostate-specific antigen (PSA) level at different ages in order to determine the risk of developing prostate cancer (CaP). We analyzed 6,651 Korean men, aged 40-69 yr. The serum PSA levels for these men were measured at one institute from 2000 to 2004 and were determined to be between 0-4 ng/mL. Patients were divided into 4 groups of 25th-percentile intervals, based on initial PSA level. Of these, the group with an increased risk was selected, and the optimal value was determined by the maximal area under a receiver-operating characteristic curve within the selected group. The risk of CaP diagnosis was evaluated by Cox regression. The mean follow-up period was 8.3 yr. CaP was detected in 27 of the 6,651 subjects. CaP detection rate was increased according to age. The optimal PSA value to distinguish the risk of CaP was 2.0 ng/mL for 50- to 69-yr-olds. Patients with a baseline PSA level greater than the optimal value had a 27.78 fold increase in the prostate cancer risk. Baseline PSA values are useful for determining the risk of developing CaP in Korean men for 50- and 69-yr-old. We suggest that PSA testing intervals be modified based on their baseline PSA levels.
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Affiliation(s)
- Kyung Kgi Park
- Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
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Hailan M, Rifat UN. Age-specific reference ranges of serum prostate-specific antigen in Iraqi men. Arab J Urol 2011; 9:273-7. [PMID: 26579311 PMCID: PMC4150601 DOI: 10.1016/j.aju.2011.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Different races have their own reference ranges of serum prostate-specific antigen (PSA) because of the influence of geographical and ethnic differences. In this study we determined the distribution of serum PSA levels in Iraqi men with no prostate cancer, to our knowledge the first such study from Iraq. SUBJECTS AND METHODS From January 2003 to May 2004, in a prospectively designed study, we included 130 Iraqi men aged 20-79 years. The criteria of an elevated PSA level, abnormal ultrasonography results and/or abnormal findings on a digital rectal examination were used to exclude patients from the study. Ethnicity was not recorded, as Iraq has a multi-ethnic status. The results were analysed using descriptive statistics, statistical tables, the arithmetic mean, standard error, standard deviation, and by two extremes. RESULTS The PSA values in different age groups (20-29, 30-39, 40-49, 50-59 and 60-79) were, respectively, ⩾0.55 to ⩽1.3, ⩽1.6, ⩽2.0, ⩽4.6 and ⩽4.8 ng/mL. There was a significant increase between the third and fourth group, and all these results were significant at P < 0.001, with the last being more significant. CONCLUSION Serum PSA measurements should be standardized according to country and ethnic groups. Our result of a PSA maximum at 4.8 ng/mL is slightly more than the international standard threshold of 4.0 ng/mL.
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Park SW, Kim CS, Lee G. Association of Polymorphisms in the Prostate-Specific Antigen (PSA) Gene Promoter with Serum PSA Level and PSA Changes after Dutasteride Treatment in Korean Men with Benign Prostatic Hypertrophy. Korean J Urol 2011; 51:824-30. [PMID: 21221201 PMCID: PMC3016427 DOI: 10.4111/kju.2010.51.12.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 11/23/2010] [Indexed: 11/18/2022] Open
Abstract
Purpose Studies of genetic variation in the prostate-specific antigen (PSA) gene have improved the diagnostic accuracy of PSA for diagnosing prostate diseases in Caucasians. However, the reference ranges and pharmacokinetics of PSA differ significantly according to race. Therefore, we evaluated the association between genetic variations in the PSA promoter area and benign prostatic hyperplasia (BPH) phenotypes in Korean BPH patients. Materials and Methods One hundred twenty-one men were enrolled. The initial serum PSA level, prostate size, and PSA changes at 3 months after treatment with dutasteride were determined. We amplified the promoter region of the PSA gene (nucleotide positions -158 to -356 and -5217 to -5429) and sequenced the products. Results Three relatively well characterized single-nucleotide polymorphisms (SNPs; rs3760722, rs266867, and rs266868), six uncharacterized SNPs (rs17554958, rs266882, rs4802754, rs2739448, rs2569733, and rs17526278), and one novel SNP (nucleotide position -5402) were found. There were no statistically significant correlations between any of the SNPs of the PSA promoter area and age-adjusted prostate sizes, initial PSA levels, or PSA variations after 3 months of dutasteride treatment. Conclusions SNPs in the PSA promoter area were not associated with BPH phenotypes. We could not predict serum PSA changes after dutasteride treatment on the basis of PSA promoter genotype in Korean patients with BPH.
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Affiliation(s)
- Sung Woon Park
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
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Chung JS, Choi HY, Song HR, Byun SS, Seo SI, Song C, Cho JS, Lee SE, Ahn H, Lee ES, Kim WJ, Chung MK, Jung TY, Yu HS, Choi YD. Preoperative nomograms for predicting extracapsular extension in Korean men with localized prostate cancer: a multi-institutional clinicopathologic study. J Korean Med Sci 2010; 25:1443-8. [PMID: 20890424 PMCID: PMC2946653 DOI: 10.3346/jkms.2010.25.10.1443] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/30/2010] [Indexed: 11/29/2022] Open
Abstract
We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.
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Affiliation(s)
- Jae Seung Chung
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Han Yong Choi
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Ryoung Song
- Department of Biostatistics and Research Affairs, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong il Seo
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Moon Kee Chung
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Tae Young Jung
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Ho Song Yu
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
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Yang JB, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Outcome of Prostate Biopsy in Men Younger than 40 Years of Age with High Prostate-Specific Antigen (PSA) Levels. Korean J Urol 2010; 51:21-4. [PMID: 20414405 PMCID: PMC2855470 DOI: 10.4111/kju.2010.51.1.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 10/19/2009] [Indexed: 11/18/2022] Open
Abstract
Purpose Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. Materials and Methods Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. Results The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. Conclusions The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated.
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Affiliation(s)
- Jin Bak Yang
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Hua L, Qiao D, Xu B, Feng N, Cheng G, Zhang J, Song N, Zhang W, Yang J, Chen J, Sui Y, Wu H. Clinical and pathological characteristics of screen-detected versus clinically diagnosed prostate cancer in Nanjing, China. Med Oncol 2010; 28:357-64. [PMID: 20077039 DOI: 10.1007/s12032-009-9409-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 12/28/2009] [Indexed: 11/25/2022]
Abstract
Previous studies have suggested that implementation of PSA screening in China is of crucial importance. This study compared clinical and pathological characteristics of screen-detected and clinically diagnosed prostate cancers and evaluated the effectiveness of PSA screening for early detection of prostate cancer in Nanjing. Between July 2004 and December 2005, 8,562 men aged ≥ 50 years were included for PSA screening. Participants with serum PSA ≥ 4.0 ng/ml were recommended for transrectal ultrasonography (TRUS)-guided prostate needle biopsy (TRNB). During the same period, 82 consecutive clinically diagnosed prostate cancers were included as controls. The clinical and pathological features of the screened versus clinically diagnosed cancers were evaluated. A total of 719 (8.4%) of screened men had PSA levels ≥ 4.0 ng/ml. Biopsy was performed in 295 men, and 58 prostate cancers were detected. The biopsy rate, positive predictive value (PPV), and detection rate were 41.0, 19.7, and 0.68%, respectively. More screened patients were found with PSA levels <20 ng/ml (55.2 vs. 22.4%, P < 0.001), Gleason scores <7 (60.3 vs. 34.1%, P = 0.002), organ-confined tumors (87.9 vs. 26.8%, P < 0.001), and opportunities for radical prostatectomy (50.0 vs. 18.3%, P < 0.001) than that in clinically diagnosed patients. PSA screening is effective for early detection of prostate cancer in Chinese elderly men. Favorable PSA levels, Gleason scores, clinical stages, and chances for radical prostatectomy are associated with PSA screening. Further studies are needed to evaluate the effect of screening on treatment outcomes and mortality of prostate cancer in Chinese.
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Affiliation(s)
- LiXin Hua
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, China.
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17
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Kim YJ, Cho YJ, Oh JE, Jeon YS, Lee SC, Kim WJ. The association between metabolic syndrome and prostate-specific antigen levels. Int J Urol 2008; 15:905-9. [DOI: 10.1111/j.1442-2042.2008.02137.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Kim YJ, Han BK, Hong SK, Byun SS, Kim WJ, Lee SE. Body mass index influences prostate-specific antigen in men younger than 60 years of age. Int J Urol 2008; 14:1009-12. [PMID: 17956528 DOI: 10.1111/j.1442-2042.2007.01879.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Prostate-specific antigen (PSA) levels can be affected by many factors. Body mass index (BMI) is suspected to influence PSA levels, but the associations are controversial. The aim of this study was to examine whether PSA levels were affected by BMI and age in Koreans. METHODS We evaluated the association between BMI and PSA in a group of 8640 Korean men (aged 40-79 years) without prostate cancer who received a general health checkup. Eligible men were classified into age groups spanning 10 years. BMI was categorized as normal (BMI <22.9), overweight (BMI 23.0-24.9), obese (BMI 25.0-29.9), and very obese (BMI > or =30) according to the re-defined World Health Organization (WHO) criterion for the Asia Pacific Region. PSA levels were stratified by age and BMI category. RESULTS Prostate-specific antigen levels decreased with increasing BMI (P trend <0.001). However, the inverse correlations between PSA and BMI were significant only among men 40-59 years old (P trend <0.05, respectively). BMI showed no significant associations with PSA in 60-79 years old (P trend >0.05, respectively). CONCLUSIONS Our study demonstrates that increased BMI is associated with decreased PSA levels only in men younger than 60 years of age. When determining whether to carry out prostate biopsy as part of early prostate cancer detection, obesity should be considered as a factor associated with reduced PSA in healthy young men (<60 years old) with marginal PSA levels.
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Affiliation(s)
- Yong-June Kim
- Department of Urology, College of Medicine, Chungbuk National University, 62 Kaeshin-dong, Heungduk-gu, Cheongju, Chungbuk, South Korea.
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19
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Koo KC, Cho KS, Kang EM, Kwon SW, Hong SJ. The Relationship between Metabolic Syndrome and Prostate Volume in Men Over Sixties who Underwent Prostate Health Check-up. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.9.813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyo Chul Koo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Min Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Won Kwon
- Department of Urology, Pochon Cha University, Pochon, Korea
- Prostate Health Council Inc., Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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20
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Jeong SJ, Han JH, Chang IH, Yu JH, Han BK, Hong SK, Byun SS, Lee SE. Pathologic Characteristics of Prostate Cancers Missed by Application of the Age-specific Prostate-specific Antigen Reference in Men over Sixties. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.8.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - June Hyun Han
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - In Ho Chang
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Hyung Yu
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Kyu Han
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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21
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Ku JH. Race-specific reference ranges of serum prostate-specific antigen levels in countries with a low incidence of prostate cancer. BJU Int 2006; 97:69-72. [PMID: 16336331 DOI: 10.1111/j.1464-410x.2005.05866.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea.
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22
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Song C, Kang T, Ro JY, Lee MS, Kim CS, Ahn H. Nomograms for the prediction of pathologic stage of clinically localized prostate cancer in Korean men. J Korean Med Sci 2005; 20:262-6. [PMID: 15831998 PMCID: PMC2808603 DOI: 10.3346/jkms.2005.20.2.262] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We analyzed the prostate cancer data of 317 Korean men with clinically localized prostate cancer who underwent radical prostatectomy at Asan Medical Center between June 1990 and November 2003 to construct nomograms predicting the pathologic stage of these tumors, and compared the outcome with preexisting nomograms. Multinomial log-linear regression was performed for the simultaneous prediction of organ-confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node metastasis (LNM) using serum prostate-specific antigen (PSA), Gleason score and clinical stage. Nomograms representing percent probabilities were constructed and compared with those presented by Partin et al. by calculating areas under the receiver operating characteristics (ROC) curves. Median serum PSA at surgery was 10.8 ng/mL, and median biopsy Gleason score was 7. Overall OCD, ECE, SVI and LNM rates were 59.6%, 20.5%, 11.7% and 8.2%, respectively, and areas under the curves were 0.724, 0.626, 0.662, and 0.794, respectively. Pathologic stage of localized prostate cancer in Korean men may be predicted using the Partin table, with acceptable accuracy for OCD and LNM, but less so for ECE and SVI.
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Affiliation(s)
- Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taejin Kang
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Y. Ro
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moo-Song Lee
- Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Park J, Sokoll LJ, Bruzek DJ, Mangold L, Gurganus R, Khan MA, Partin AW, Chan DW, Veltri RW. Comparison of total prostate-specific antigen and derivative levels in a screening population of black, white, and Korean-American men. ACTA ACUST UNITED AC 2004; 2:173-6. [PMID: 15040861 DOI: 10.3816/cgc.2003.n.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Numerous studies have assessed serum total PSA (tPSA) levels among different races. We extended the serum biomarker profiling using prostate-specific antigen (PSA) derivatives in age-matched screening populations that included white, black, and Korean-American patients. The median ages were 61 years for white and black patients and 63 years for Korean-American patients. Serum samples from 70 men in each ethnic group were analyzed using 3 different tPSA assays (Tosoh AIA 600II, Bayer Immuno-1, Roche Elecsys 2010). The percentage of free PSA (fPSA) was measured directly by Roche Elecsys 2010 immunoassay and then calculated from complexed PSA (cPSA) and tPSA results determined with the Bayer Immuno-1. The percentage of cPSA was determined using cPSA and tPSA assayed by the Immuno-1 method. Statistical analyses included nonparametric Kruskal-Wallis and analysis of variance (ANOVA) evaluations. There were no differences noted in the tPSA values based on ANOVA among the 3 races irrespective of the assay platform methodology employed. Also, the PSA derivatives, percentages of fPSA and cPSA, evaluated using the Kruskal-Wallis test, showed no significant differences for either derivative assayed on 2 different assay platforms among the 3 groups. In a contemporary screening population comparing tPSA, percentage of fPSA, and percentage of cPSA levels in 3 races, there were no significant differences identified among the groups.
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Affiliation(s)
- Jae Park
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Marburg 409, 600 North Wolfe Street, Baltimore, MD 21287, USA
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He D, Wang M, Chen X, Gao Z, He H, Zhau HE, Wang W, Chung LWK, Nan X. Ethnic differences in distribution of serum prostate-specific antigen: a study in a healthy chinese male population. Urology 2004; 63:722-6. [PMID: 15072888 DOI: 10.1016/j.urology.2003.10.066] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 10/29/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the normal distribution of serum prostate-specific antigen (PSA) levels in healthy Chinese men, because, until recently, studies conducted to establish normal serum PSA values have not involved a Chinese population. METHODS Between September 1999 and December 2001, 1096 healthy Chinese men aged 23 to 85 years, who had undergone a routine health examination, were recruited to this study. All underwent detailed clinical examinations, including serum PSA determination and digital rectal examination. All men with abnormal digital rectal examination findings and/or an abnormal serum PSA level (greater than 4.0 ng/mL) underwent transrectal ultrasound-guided sextant biopsy. RESULTS The median serum PSA concentration was 0.50 ng/mL (95th percentile 1.20) for men 23 to 29 years old (n = 77); 0.55 ng/mL (95th percentile 1.21) for men 30 to 39 years old (n = 189); 0.54 ng/mL (95th percentile 1.23) for men 40 to 49 years old (n = 233); 0.82 ng/mL (95th percentile 2.35) for men 50 to 59 years old (n = 177); 0.93 ng/mL (95th percentile 3.20) for men 60 to 69 years old (n = 265); and 1.17 ng/mL (95th percentile 3.39) for men 70 years old or older (n = 155). The serum PSA concentration correlated with age (P <0.001), with an increase of approximately 1.1% annually. No change occurred in the median serum PSA value and 95th percentile in men younger than 50 years old; a gradual increase was observed in men older than 50 years. In those 50 years old or older, the median and 95th percentile serum PSA values for Chinese men were significantly lower than those for other races and even for other Asian men. CONCLUSIONS These findings further confirm that the serum PSA level correlates with age. Moreover, the distribution and cutoff value of the serum PSA level differs along ethnic lines. In addition, our findings raise the question of whether lowering the PSA cutoff may enhance the detection of cancer in Chinese men who have the lowest prostate cancer rate.
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Affiliation(s)
- Dalin He
- Department of Urology, First Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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25
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Lee SE. The Diagnostic Value of Prostate-specific Antigen and the Necessity of Routine Laboratory Examination for Early Detection. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.5.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang Eun Lee
- Department of Urology, Seoul National University College of Medicine, Bundang Hospital, Korea.
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