Exploration and validation of optimal cut-off values for tPSA and fPSA/tPSA screening of prostate cancer at different ages
10.3760/cma.j.cn112152-20230805-00062
- VernacularTitle:不同年龄下总前列腺特异性抗原和游离/总前列腺特异性抗原比值筛查前列腺癌的最佳切点值探讨及验证
- Author:
Xiaomin LIU
1
;
Hongyuan DUAN
;
Dongqi ZHANG
;
Chong CHEN
;
Yuting JI
;
Yunmeng ZHANG
;
Zhuowei FENG
;
Ya LIU
;
Jingjing LI
;
Yu ZHANG
;
Chenyang LI
;
Yacong ZHANG
;
Lei YANG
;
Zhangyan LYU
;
Fangfang SONG
;
Fengju SONG
;
Yubei HUANG
Author Information
1. 国家恶性肿瘤临床医学研究中心 天津市恶性肿瘤临床医学研究中心 天津市肿瘤分子流行病重点实验室 天津医科大学肿瘤医院肿瘤流行病与生物统计研究室，天津 300060
- Keywords:
Prostate neoplasms;
tPSA;
fPSA;
Screening;
Age-specific screening cut-off values
- From:
Chinese Journal of Oncology
2024;46(4):354-364
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To determine the total and age-specific cut-off values of total prostate specific antigen (tPSA) and the ratio of free PSA divided total PSA (fPSA/tPSA) for screening prostate cancer in China.Methods:Based on the Chinese Colorectal, Breast, Lung, Liver, and Stomach cancer Screening Trial (C-BLAST) and the Tianjin Common Cancer Case Cohort (TJ4C), males who were not diagnosed with any cancers at baseline since 2017 and received both tPSA and fPSA testes were selected. Based on Cox regression, the overall and age-specific (＜60, 60-＜70, and ≥70 years) accuracy and optimal cut-off values of tPSA and fPSA/tPSA ratio for screening prostate cancer were evaluated with time-dependent receiver operating characteristic curve (tdROC) and area under curve (AUC). Bootstrap resampling was used to internally validate the stability of the optimal cut-off value, and the PLCO study was used to externally validate the accuracy under different cut-off values.Results:A total of 5 180 participants were included in the study, and after a median follow-up of 1.48 years, a total of 332 prostate cancer patients were included. In the total population, the tdAUC of tPSA and fPSA/tPSA screening for prostate cancer were 0.852 and 0.748, respectively, with the optimal cut-off values of 5.08 ng/ml and 0.173, respectively. After age stratification, the age specific cut-off values of tPSA in the <60, 60-<70, and ≥70 age groups were 3.13, 4.82, and 11.54 ng/ml, respectively, while the age-specific cut-off values of fPSA/tPSA were 0.153, 0.135, and 0.130, respectively. Under the age-specific cut-off values, the sensitivities of tPSA screening for prostate cancer in males <60, 60-70, and ≥70 years old were 92.3%, 82.0%, and 77.6%, respectively, while the specificities were 84.7%, 81.3%, and 75.4%, respectively. The age-specific sensitivities of fPSA/tPSA for screening prostate cancer were 74.4%, 53.3%, and 55.9%, respectively, while the specificities were 83.8%, 83.7%, and 83.7%, respectively. Both bootstrap's internal validation and PLCO external validation provided similar results. The combination of tPSA and fPSA/tPSA could further improve the accuracy of screening.Conclusion:To improve the screening effects, it is recommended that age-specific cut-off values of tPSA and fPSA/tPSA should be used to screen for prostate cancer in the general risk population.
