The use of percent free prostate specific antigen for staging clinically localized prostate cancer

Jürgen Pannek, Harry G. Rittenhouse, Daniel W. Chan, Jonathan I. Epstein, Patrick C. Walsh, Alan W. Partin

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The free-to-total serum prostate specific antigen (PSA) ratio (percent free PSA) has been demonstrated to have clinical use for early detection of men with prostate cancer with total PSA levels between 4.0 and 10.0 ng./ml. Several studies evaluating the usefulness of percent free PSA for the staging of clinically localized prostate cancer have provided conflicting results. We further investigate the usefulness of percent free PSA for staging of clinically localized prostate cancer. Materials and Methods: In 263 men with clinically localized prostate cancer who underwent radical prostatectomy total PSA and free PSA were measured preoperatively. Pathological stages were classified as organ confined in 134 cases, capsular penetration in 92, seminal vesicle involvement in 7, involvement of the surgical margins in 20 and lymph node involvement in 10. Results: Percent free PSA was significantly different between men with organ confined versus nonorgan confined tumors (p <0.0001) and between those with favorable versus unfavorable pathology (p <0.0001). A cutoff of 12% free PSA provided a 72% positive predictive value and 52% negative predictive value for favorable pathology. A cutoff of 15% free PSA provided a 76% and 53% positive and negative predictive value, respectively, for organ confined disease. Conclusions: These data demonstrate that the use of percent free PSA may be of additional value for the staging of clinically localized prostate cancer. The recommendations for cutoff levels of percent free PSA for detection and staging of localized prostate cancer are preliminary and can only be given for this particular assay. A large multicenter trial, controlling for age, stage and grade distribution, as well as for a uniform pathological evaluation and comparable total and free PSA assays, is required to elucidate this issue further.

Original languageEnglish (US)
Pages (from-to)1238-1242
Number of pages5
JournalJournal of Urology
Volume159
Issue number4
DOIs
StatePublished - Apr 1998
Externally publishedYes

Keywords

  • Prostate-specific antigen
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'The use of percent free prostate specific antigen for staging clinically localized prostate cancer'. Together they form a unique fingerprint.

Cite this