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| References
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Prostate-screening,
benign enlargement and cancer |
| 3.
Bangma CH, Rietbergen JW, Kranse R, Blijenberg BG, Petterson
K, Schroder FH et al. The free-to-total prostate
specific antigen ratio improves the specificity of prostate
specific antigen in screening for prostate cancer in the general
population. Journal d.Urologie Vol 157.(6.) (pp.2191.-2198.),
1997.
Abstract: Purpose: The ratio between free and total prostate
specific antigen (PSA) in serum improves the specificity
of total serum PSA for the detection of prostate carcinoma
in select populations. The value of the free-to-total PSA
ratio for a PSA of 4.0 to 10.0 ng./ml. was analyzed in a
screening population. Materials and Methods: From 4,800
participants 55 to 76 years old 977 biopsies were obtained
because of an abnormal digital rectal examination, suspicious
transrectal ultrasonography and total serum PSA 4.0 ng./ml.
or more. Of 191 patients with prostate carcinoma detected
101 had a serum PSA of 4.0 to 10.0 ng./ml. and 54 of them
underwent radical prostatectomy. A free- to-total PSA ratio
of 0.20, age specific PSA reference ranges and a PSA density
of 0.12 ng./ml./cc were evaluated for the ability to increase
the specificity of total serum PSA in predicting positive
prostate biopsy results. Results: Receiver operating characteristics
curves for the free-to- total PSA ratio showed a significant
increase in specificity compared to PSA. Retrospective application
of age specific PSA reference ranges, the free-to- total
PSA ratio and the PSA density decreased the number of biopsies
significantly by up to 40% in our study, with a decrease
in cancer detection rate of 12%. When used in combination
with digital rectal examination, the pathological stage
of undetected carcinomas appeared favorable. Conclusions:
The free-to-total PSA ratio may be used to decrease biopsies
in patients with an intermediate PSA of 4.0 to 10.0 ng./ml.
[References: 17]
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