Significance of free to total PSA ratio in men with normal digital rectal examination, normal transrectal ultrasonography, and intermediate total serum PSA levels

Özveri H., ÇAM H. K., TARCAN T., Türkeri L., Akdaş A.

Journal of B.U.ON., vol.6, no.1, pp.79-82, 2001 (SCI-Expanded) identifier

  • Publication Type: Article / Article
  • Volume: 6 Issue: 1
  • Publication Date: 2001
  • Journal Name: Journal of B.U.ON.
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.79-82
  • Acibadem Mehmet Ali Aydinlar University Affiliated: No


Purpose: To investigate the value of free to total prostate specific antigen (PSA) ratio in the detection of prostate cancer (Pca) in patients with intermediate total PSA levels (4-10 ng/ml), normal digital rectal examination (DRE) and normal transrectal ultrasonography (TRUS). Patients and methods: A total of 94 patients with normal DRE and TRUS, who attended the outpatient urology department with lower urinary tract symptoms underwent TRUS-guided systemic and lesion-directed biopsies due to intermediately elevated total PSA levels (4-10 ng/ml). Results: Histopathological examination revealed 23 (24.4%) cases with Pca. Cancer detection ratio was 1/4 biopsies based on total PSA levels between 4-10 ng/ml. Considering the free to total PSA ratio (cutoff ratio 0.15), 41 patients were below 0.15 and 18 (44%) of them had Pca. Thus, 53 biopsies would be avoided, while 21.7% (5/23) of cancer cases would have been missed. The cancer detection ratio was 1/2.2 biopsies, based on the free to total PSA ratio <0.15. On the other hand, taking 0.10 as the cutoff level of the free to total PSA ratio, there were 14 patients and 11(78.6%) of them had Pca. But in this way 52% (12/23) of cancer cases would have been missed. Conclusion: Free to total PSA ratio alone would spare unnecessary biopsies at the expense of missing at least 20% of Pca cases. Therefore, according to our results, distinct use of free to total PSA ratio should not be advised as a biopsy indicator.