Percentage of free prostate‐specific antigen (PSA) is a useful method in deciding to perform prostate biopsy with higher core numbers in patients with low PSA cut‐off values

Abstract

The aim of this study was to evaluate the predictive role of percentage of free prostate-specific antigen (%fPSA) cut-points in prostate cancer (PCa) detection in patients with total PSA (tPSA) levels between 2.5 ng/mL and 10.0 ng/mL. In total, 1321 consecutive initial transrectal ultrasound (TRUS)-guided 12-core biopsies performed between 2005 and 2011 were evaluated retrospectively. Benign pathologies, high-grade prostatic intraepithelial neoplasia, and atypical small acinary proliferations were categorized as noncancerous (benign), and prostate adenocarcinomas were categorized as cancerous (malignant). The patients were categorized according to: Catalona's published %fPSA categories (<10%, 10-15%, 15-20%, 20-25%, or > 25%); digital rectal examination (DRE) results [benign (negative) or suspicious of malignancy (positive)]. There was a significant relationship between the %fPSA cut-points and detection of PCa in DRE-negative patients. The presence of a 10% cut-point increased the probability of PCa threefold. The %fPSA was significantly more related to PCa than the tPSA value in receiver operating characteristic (ROC) curve analyses (p = 0.001). Based on our findings, a lower %fPSA, especially <10%, is an important parameter when deciding whether to perform a biopsy on patients with a tPSA between 2.5 ng/mL and 10 ng/mL.

Significant Diagnostic Value of Free-Serum PSA (FPSA)/Prostate-Specific Antigen Density (PSAD) and (F/T)/PSAD for Prostate Cancer of the Chinese Population in a Single Institution

“…Moreover, many studies focused their attention on other related parameters, such as free-to-total PSA (F/T) values and prostate-specific antigen density (PSAD), showing higher diagnostic accuracy than that with PSA itself [11–13]. Two parameters, PSAD, and F/T are most commonly used to improve the diagnostic accuracy of PSA.…”

A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

“…The most commonly used marker in the diagnosis of prostate cancer is PSA [2]. The upper limit for gray-zone PSA has been determined as 10 ng/ml in numerous studies [6][7][8]15,[17][18]. Some other studies, though few in number, suggest that the upper limit for gray-zone PSA may show ethnic variation and propose that this limit is likely to be higher in countries where PCa is less common, particularly in Far Eastern countries [9,19].…”

“…The cancer detection rate per core was calculated in accordance with the International Society of Urological Pathology (ISUP) grading system, which is based on primary and secondary Gleason scores [15]. Clinically significant prostate cancer (sPCa) was considered as biopsy Gleason score ≥3+4 or maximum cancer core length ≥5 mm.…”

Determination of an optimum cut-off point for %fPSA/tPSA to improve detection of prostate cancer

“…[25] Yilmaz et al suggested a cut-off of 10% whereas Pourmand et al arrived at 13%. [26][27] The study conducted by Dalva et al came to a cut-off value of 15%. [28] A study conducted on an Indian population (sample size -101 patients) by Thakur et al determined a cut-off value of 12%.…”