The Xu's chart for prostate biopsy: a visual presentation of the added value of biomarkers to prostate-specific antigen for estimating detection rates of prostate cancer

recommendation for additional biomarkers. A more comprehensive evaluation of PCa risk using existing risk assessment tools such as nomograms can be followed once additional biomarkers are measured. The current version of the chart is only a prototype and should be further developed to include the detection rate of aggressive PCa, and validated in larger studies. PCa is the second most frequently diagnosed cancer and the sixth leading cause of cancer‐related death in men, with an estimated 914 000 new cases and 258 000 deaths per year globally in 2008.1,2 PCa incidence rate differs widely among countries and regions, possibly due to differences in the adoption rate of PSA screening for PCa, as well as inherited risk and environmental exposures such as diet. The trend of PCa incidence in the last several decades also differed considerably among various countries and regions. In the United States, the incidence rate increased sharply in the early to mid‐1990s with the introduction of PSA screening for PCa, and declined since.3 In Shanghai, China, the age‐adjusted incidence rate of PCa increased from 2.3 per 100 000 during 1988–1992 to 6.9 per 100 000 during 1998 to 2002,4 and reached 16.0 per 100 000 in 2007 (unpublished data). The sevenfold increase of PCa incidence in Shanghai coincided with the gradual introduction of PSA screening for PCa during that period of time.