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Free/total PSA ratio can help in the prediction of high gleason score prostate cancer in men with total serum prostate specific antigen (PSA) of 3–10 ng/ml

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Abstract

Purpose We evaluate the use of free/total prostate specific antigen (PSA) ratio in improving the prediction of cancers of higher Gleason scores. Patients and methods A total of 164 patients with total serum PSA of 3.0–10.0 ng/ml underwent extended TRUS-guided core biopsy. In each man serum free PSA was measured and the free/total (F/T) PSA ratio was calculated. Out of the 164 patients who underwent TRUS-biopsy, cancer was detected in 62 (37.8%) patients. The mean age for the 62 patients with histologically proven prostate cancer was 62.3 ± 5.5 years (49–73). The histological findings were compared with the free/total PSA ratio. Pearson Correlation Coefficient test and Chi-Square test (χ2-test) were used for statistical analysis and p < 0.05 was considered statistically significant. ResultsOf the 62 patients, 37 (59.7%) patients had cancers of low Gleason scores (score 2–6) and 25 (40.3%) patients had cancers of high Gleason scores (score 7–10). Free PSA < 0.15% was found in 19 (30.6%) patients, from 15 to 20% in 23 (37.1%) patients and > 20% in 20 (32.3%) patients. There was a significant positive correlation between total PSA and Gleason score (Pearson Correlation Coefficient test, r = 0.328, p < 0.01). Also, there was a significant increase in Gleason score with lower F/T PSA ratio (r = −0.668, p < 0.001). Among the 19 patients with free PSA ratio < 15%, 14 (73.7%) patients had cancers of high Gleason score while 5 (26.3%) patients had cancers of low Gleason score. In patients (n = 23) with free PSA ratio15–20%, 10 (43.5%) had cancers of high Gleason score and 13 (56.5%) had cancers of low Gleason score. In the 20 patients with free PSA ratio > 20%, 1 patient (5%), had prostate cancer of high Gleason score and the remaining 19 (95%) patients had low Gleason scores. There was a significant relation between lower F/T PSA ratios and higher Gleason scores, Chi-Square test, χ2 = 19.3, p < 0.01. Conclusions In this study, men with prostate cancer and lower F/T PSA ratio were at a higher risk of having higher Gleason scores (7–10) and those with higher F/T PSA ratio were more likely to have lower Gleason scores.

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Authors and Affiliations

  1. Department of Urology Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    Ahmed A. Elabbady

  2. Department of Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    Mahrousa M. Khedr

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  1. Ahmed A. Elabbady
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  2. Mahrousa M. Khedr
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Elabbady, A.A., Khedr, M.M. Free/total PSA ratio can help in the prediction of high gleason score prostate cancer in men with total serum prostate specific antigen (PSA) of 3–10 ng/ml. Int Urol Nephrol 38, 553–557 (2006). https://doi.org/10.1007/s11255-006-6672-5

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