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Purpose The prostate-specific antigen(PSA)"grey zone" in Chinese men should be higher than the traditional value(2.5-10.0 ng/ml)since incidence of prostate cancer in Chinese men was relative low.The usefulness of percent free PSA in predicting prostate cancer based on Western populations may introduce sizable bias when applied to a Chinese cohort.We then assessed the efficiencies of percent free PSA in the diagnosis of prostate cancer in Chinese men with PSA of both 2.5-10.0 and 10.1-20.0ng/ml.Materials and Methods A total of 558 men with a PSA of 2.5-20.0 ng/ml who had undergone prostatic biopsy for detecting prostate cancer from two Chinese centers were included(Guangzhou First People's Hospital and Zhujiang Hospital).The rates of prostate cancer in different percent free PSA ranges were evaluated.Receiver operating characteristic curve(ROC)was used to evaluate and compare the efficiency of PSA and percent free PSA in the diagnosis of prostate cancer.Results The areas under ROC(AUCs)for percent free PSA as continuous variables in predicting prostate cancer were not higher than those for PSA,although prostate cancer detection rates increased accordingly with percent free PSA decreased in men with a PSA of 2.5-10.0,10.1-20.0,and 2.5-20.0 ng/ml.Similarly,in men age < 70 and ≥ 70 years and prostate volume < 40 and ≥ 40 ml,AUCs showed percent free PSA was not a better variable than PSA in predicting prostate cancer.Conclusions Percent free PSA does not improve effectiveness for prostate cancer detection in Chinese men with a PSA of 2.5-10.0 and 10.1-20.0 ng/ml.Our results indicate that using percent free PSA as a tool for detecting prostate cancer should be race individualized.Further studies are warranted.