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Original Research

Open Access Special Issue

The diagnostic value of a new formula combining age and prostate volume in prostate cancer

  • Xiaobo Yang1,†
  • Jiahao Shan2,†
  • Qiang Zhang1
  • Zhongyu Yuan2
  • Haoran Xu2
  • Ziyang Liu2
  • Xiaojie Zhou2
  • Wenzhuo Ma2
  • Hongbin Shi1

1Department of urology, General Hospital of Ningxia Medical University, 750004 Yinchuan, Ningxia, China

2School of Clinical Medicine, Ningxia Medical University, 750004 Yinchuan, Ningxia, China

DOI: 10.31083/jomh.2021.080

Submitted: 15 April 2021 Accepted: 10 June 2021

Online publish date: 22 July 2021

*Corresponding Author(s): Hongbin Shi E-mail:

† These authors contributed equally.

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Background and objective: This study combined two clinical indicators (age and prostate volume (PV)) to generate age to PV (AVR) ratio, whose diagnostic value for prostate cancer (PCa) was examined based on prostate specific antigen (PSA) in the range of 4--20.0 ng/mL.

Methods: The medical records of patients who underwent transrectal ultrasound-guided biopsy of the prostate in our hospital from June 2015 to June 2019 were examined retrospectively. According to the pathological results of the biopsy, the patients were divided into the PCa and benign prostatic hyperplasia (BPH) groups. Receiver operating characteristic (ROC) curves for TPSA, PSAD, PV, (F/T)PSA, AVR, and PSA-AV were plotted with SPSS 26.0 and GraphPad Prism 5.0, and areas under the ROC curves (AUROCs) were determined and compared by Delong test. A log-linear model was used to compare AVR and other parameters with similar high sensitivities, for specificity.

Results: The AUROC for AVR was significantly different from those of TPSA (p < 0.001), PV (p = 0.004),(F/T)PSA (p < 0.001), and PSA-AV (p = 0.006), and similar to that of PSAD (p = 0.064). With the same high sensitivity (90.0%), log-linear model analysis showed that the specificity of AVR was significantly higher than those of TPSA and (F/T)PSA (p < 0.01), while there were no significant differences among AVR and PSAD, PV and PSA-AV.

Conclusion: With PSA in the range of 4--20.0 ng/mL, AVR may be useful in sparing an invasive intervention for a number of patients.


Prostate cancer; Prostate-specific antigen density; PSA-AV score; Prostate-specific antigen

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Xiaobo Yang,Jiahao Shan,Qiang Zhang,Zhongyu Yuan,Haoran Xu,Ziyang Liu,Xiaojie Zhou,Wenzhuo Ma,Hongbin Shi. The diagnostic value of a new formula combining age and prostate volume in prostate cancer. Journal of Men's Health. 2021.doi:10.31083/jomh.2021.080.


[1] Daniyal M, Siddiqui ZA, Akram M, Asif HM, Sultana S, Khan A. Epidemiology, Etiology, Diagnosis and Treatment of Prostate Cancer. Asian Pacific Journal of Cancer Prevention. 2014; 15: 9575–9578.

[2] Siegel RL, Miller KD, Jemal A. Cancer statistics. CA: A Cancer Journal for Clinicians. 2018; 68: 7–30.

[3] Li M, Zhang SW, Ma JH, Chen WQ, Na YQ. Comparative study on the incidence trend of prostate cancer in some cities and counties in China. Chinese Journal of Urology,2009(06):10-12.

[4] Han SJ, Zhang SW, Chen WQ, LI. CL. Analysis on the status and prevalence of prostate cancer in China. Clinical Oncology. 2013; 18: 330–334.

[5] Wang MC, Papsidero LD, Kuriyama M, Valenzuela LA, Murphy GP, Chu TM. Prostate antigen: a new potential marker for prostatic cancer. Prostate. 1981; 2: 89–96.

[6] Gui-zhong L, Libo M, Guanglin H, Jianwei W. The correlation of extent and grade of inflammation with serum PSA levels in patients with IV prostatitis. International Urology and Nephrology. 2011; 43: 295–301.

[7] Lee A, Lim J, Gao X, Liu L, Chia SJ. A nomogram for prediction of prostate cancer on multi-core biopsy using age, serum prostate-specific antigen, prostate volume and digital rectal examination in Singapore. Asia-Pacific Journal of Clinical Oncology. 2017; 13: e348–e355.

[8] Gupta M, McCauley J, Farkas A, Gudeloglu A, Neuberger MM, Ho Y, et al. Clinical practice guidelines on prostate cancer: a critical appraisal. Journal of Urology. 2015; 193: 1153–1158.

[9] Xie SW, Li HL, Du J, Xia JG, Guo YF, Xin M, et al. Influence of serum prostate-specific antigen (PSA) level, prostate volume, and PSA density on prostate cancer detection with contrast-enhanced sonography using contrast-tuned imaging technology. Journal of Ultrasound in Medicine. 2013; 32: 741–748.

[10] Oesterling JE, Jacobsen SJ, Chute CG, Guess HA, Girman CJ, Panser LA, et al. Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. Journal of the American Medical Association. 1993; 270: 860–864.

[11] Xie GS, Huang YH, Yan CY, Pu JX, Li G, Ouyang J, et al. Age-specific analysis of prostate-specific antigen and related parameters in 22055 middle-aged and elderly men. Chinese Journal of Urology. 2013; 34: 613–617.

[12] Chen R, Xie LP, Zhou LQ, Huang YR, Fu Q, He DL, et al. Investigation report on the status of prostate biopsy in member hospitals of China Prostate Cancer Alliance. Chinese Journal of Urology. 2015; 36: 342–345.

[13] Sighinolfi MC, Rocco B. Re: EAU Guidelines: Prostate Cancer 2019. European Urology. 2019; 76: 871.

[14] Page BR. The ‘student’’ of the student’s t‐test. Physics Teacher. 1995; 33: 490–496.

[15] Pacut A. How to use the Mann-Whitney test to detect a change in distribution for groups. Acta Neurobiologiae Experimentalis. 1987; 47: 19–26.

[16] Song HL, He J, Yu HT, Li L. Using the area under the ROC curve to evaluate and compare two related diagnostic tests. Journal of Second Military Medical University. 2006; 5.

[17] Qian J, Chen PY. Discussion on the Significance of Computational Observation Test Power in Hypothesis Test. Chinese Health Statistics. 2005; 3.

[18] Ma LM, Wang Jun. Application of log-linear model in clinical trial data analysis. Chinese Journal of Clinical Pharmacology. 2011; 3.

[19] Papsidero LD, Kuriyama M, Wang MC, Horoszewicz J, Leong SS, Valenzuela L, et al. Prostate antigen: a marker for human prostate epithelial cells. Journal of the National Cancer Institute. 1981; 66: 37–42.

[20] Bigler SA, Deering RE, Brawer MK. Comparison of microscopic vascularity in benign and malignant prostate tissue. Human Pathology. 1993; 24: 220–226.

[21] Ford TF, Butcher DN, Masters JR, Parkinson MC. Immunocyto-chemical Localisation of Prostate-specific Antigen: Specificity and Application to Clinical Practice. British Journal of Urology. 1985; 57: 50–55.

[22] Rosenberg S, Stracher A, Burridge K. Isolation and characterization of a calcium-sensitive alpha-actinin-like protein from human platelet cytoskeletons. Journal of Biological Chemistry. 1981; 256: 12986–12991.

[23] Yamamoto S, Maruyama T, Kondoh N, Nojima M, Takiuchi H, Hirota S, et al. Diagnostic efficacy of free to total ratio of prostate-specific antigen and prostate-specific antigen velocity, singly and in combination, in detecting prostate cancer in patients with total serum prostate-specific antigen between 4 and 10 ng/mL. International Urology and Nephrology. 2008; 40: 85–89.

[24] Caliskan S. Diagnostic efficacy of free prostate-specific antigen/total prostate-specific antigen ratio for the diagnosis of prostate cancer in low concentration (≤4 ng/mL) and intermediate levels of total prostate-specific antigen (4.01-10.0 ng/mL). Journal of Cancer Re-search and Therapeutics. 2017; 13: 279–283.

[25] Huang Y, Li ZZ, Huang YL, Song HJ, Wang YJ. Value of free/total prostate-specific antigen (f/t PSA) ratios for prostate cancer detection in patients with total serum prostate-specific antigen between 4 and 10 ng/mL: a meta-analysis. Medicine. 2018; 97: e0249.

[26] Zhou LQ, Chen WM, Na YQ, Huang YY, Feng T HJ. Comparison of serum PSA level and free PSA ratio in patients with benign prostatic hyperplasia and prostate cancer %. Chinese Journal of Urology. 2002; 33–36.

[27] Bo CL, Ma TL. Sichuan province in the central and western regions apparent healthy elderly prostate specific antigen reference range. Mark Immune Analysis and Clinical. 2019; 26: 1710–1713.

[28] Ozden E, Turgut AT, Talas H, Yaman O, Gogus O. Effect of dimensions and volume of the prostate on cancer detection rate of 12 core prostate biopsy. International Urology and Nephrology. 2007; 39: 525–529.

[29] Tang P, Jin X, Uhlman M, Lin Y, Deng X, Wang B, et al. Prostate volume as an independent predictor of prostate cancer in men with PSA of 10-50 ng ml-1. Asian Journal of Andrology. 2013; 15: 409–412.

[30] Zheng XY, Xie LP, Wang YY, Ding W, Yang K, Shen HF, et al. The use of prostate specific antigen (PSA) density in detecting prostate cancer in Chinese men with PSA levels of 4-10 ng/mL. Journal of Cancer Research and Clinical Oncology. 2008; 134: 1207–1210.

[31] Yusim I, Krenawi M, Mazor E, Novack V, Mabjeesh NJ. The use of prostate specific antigen density to predict clinically significant prostate cancer. Scientific Reports. 2020; 10: 20015.

[32] Nan LB, Yin XT, Gao JP. Significant Diagnostic Value of Free-Serum PSA (FPSA)/Prostate-Specific Antigen Density (PSAD) and (F/T)/PSAD for Prostate Cancer of the Chinese Population in a Single Institution. Medical Science Monitor. 2019; 25: 8345–8351.

[33] JL. Q. Disease burden analysis of prostate cancer in Chinese men from 1990 to 2013. Chinese journal of epidemiology. 2016; 6.

[34] Feletto E, Bang A, Cole-Clark D, Chalasani V, Rasiah K, Smith DP. An examination of prostate cancer trends in Australia, England, Canada and USA: is the Australian death rate too high? World Journal of Urology. 2015; 33: 1677–1687.

[35] Patel S, Issa MM, El-Galley R. Evaluation of novel formula of PSA, age, prostate volume, and race in predicting positive prostate biopsy findings. Urology. 2013; 81: 602–606.

[36] Uçer O, Yücetas U, Çelen I, Toktas G, Müezzinoglu T. Assessment of PSA-Age volume score in predicting positive prostate biopsy findings in Turkey. International Brazilian Journal of Urology. 2015; 41: 864–868.

[37] Wu YS, Wu XB, Zhang N, Jiang GL, Yu Y, Tong SJ, et al. Evaluation of PSA-age volume score in predicting prostate cancer in Chinese population. Asian Journal of Andrology. 2018; 20: 324–329.

[38] Gjengstø P, Paus E, Halvorsen OJ, Eide J, Akslen LA, Wentzel-Larsen T, et al. Predictors of prostate cancer evaluated by receiver operating characteristics partial area index: a prospective institutional study. Journal of Urology. 2005; 173: 425–428.

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