Introduction: The crude incidence rate of prostate cancer (PCa) in China was 9.8/105 in 2014 and has been increasing rapidly over years. Since PCa screening has not been performed on national-wide scale, most of patients were diagnosed at the advanced stage. The present study is the biggest single center PCa screening project in China, including the largest number of subjects ever reported. Since the benefit of prostate-specific antigen (PSA) based screening is still controversial, a combination of PSA, multi-parametric MRI (mpMRI) and targeted biopsy was used in screening to improve detection rate. The objective is to investigate the incidence of PCa among males in Nanjing and whether combination of PSA, mpMRI and targeted biopsy is a feasible approach for screening PCa in China.
Methods: From January 2018 to October 2019, we collected serum samples from 33 939 men aged =50 years in 25 community health service centers in Nanjing. We proposed mpMRI for those with serum PSA =4 ng/mL. Transperineal systematic biopsy (TPSB) combined with MRI /ultrasound fusion targeted biopsy (TB) was offered for those scored =3 on the Prostate Imaging-Reporting and Data System Version 2 (PI-RADS v2). TPSB alone was offered for those scored <3 and serum PSA =10 ng/mL. Subjects with serum PSA between 4 ng/mL and 10 ng/mL and PI-RADS score <3 points were referred to follow-up examinations every 6 months. An Ethical Committee approval has been obtained.
Results: Among the 33 939 male subjects, 4111(12.1%) were found with serum PSA=4 ng/mL. Only 1199(29%) of them received mpMRI examination, 853(71.1%) of the 1199 men had PI-RADS scores =3. Finally, 363(59.1%) of the 591 males that underwent prostate biopsy were diagnosed with PCa, with a total detection rate of 1.07% in all the subjects. Of the 343 patients with complete pathological data, 314 (91.5%) were found with clinically significant PCa, 128(37.3%) with localized, 186 (54.2%) with locally advanced and 29 (8.5%) with metastatic malignancy, 34(9.9%) in stage ?, 72(21.0%) in stage ?, 156 (45.5%) in stage ? and 81 (23.6%) in stage ?.
Conclusions: The detection rate of PCa in Nanjing is 1.07%. PCa has become a serious threaten for Chinese citizen. Screening for PCa among high-risk population through a combination of PSA assay, mpMRI and targeted biopsy is a feasible approach in China. Source of