title: Prediction of post-radical prostatectomy pathological outcome for stage T1c prostate cancer with percent free prostate specific antigen: a prospective multicenter clinical trial.
abstract: OBJECTIVE
  Prostate specific antigen (PSA) exists in bound (complexed) and unbound (free) forms in serum. The percentage of free PSA enhances the specificity of PSA testing for prostate cancer detection. We evaluated the use of percent free PSA preoperatively to predict pathological stage.
  
  
  METHODS
  A total of 379 men with prostate cancer and 394 with benign prostatic disease 50 to 75 years old were enrolled in this prospective study at 7 medical centers. All subjects had a palpably benign prostate gland, serum PSA 4.0 to 10.0 ng./ml. and a histologically confirmed diagnosis. The Hybritech Tandem PSA and free PSA assays were used. Of the 379 cancer patients 268 (71%) underwent radical prostatectomy.
  
  
  RESULTS
  Higher percent free PSA levels were associated with more favorable histopathological findings in prostatectomy specimens. A value of 15% free PSA provided the greatest discrimination in predicting favorable pathological outcome. Organ confined cancer, Gleason sum less than 7 and small tumors (10% or less involvement of the prostate) were noted in 75% of patients with greater than 15% and only 34% with 15% or less free PSA (p<0.001). Multivariate logistic regression analysis revealed percent free PSA to be the strongest predictor of postoperative pathological outcome (odds ratio 2.25), followed by biopsy Gleason sum (2.06) and patient age (1.35). Total PSA was not predictive in this cohort but has been shown in prior studies to be predictive of outcome when a broader range of PSA values is evaluated.
  
  
  CONCLUSIONS
  Percent free PSA may be used for risk assessment of the presence (diagnosis) and stage of prostate cancer in men with PSA between 4 and 10 ng./ml. Percent free PSA may be combined with PSA, digital rectal examination and biopsy findings to help predict postoperative pathological stage and grade, and may assist the patient and physician in making more informed treatment decisions.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Southwick
authors.forename: W J
authors.initials: WJ
authors.lastname: Catalona
authors.forename: A W
authors.initials: AW
authors.lastname: Partin
authors.forename: K M
authors.initials: KM
authors.lastname: Slawin
authors.forename: M K
authors.initials: MK
authors.lastname: Brawer
authors.forename: R C
authors.initials: RC
authors.lastname: Flanigan
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: J P
authors.initials: JP
authors.lastname: Richie
authors.forename: P C
authors.initials: PC
authors.lastname: Walsh
authors.forename: P T
authors.initials: PT
authors.lastname: Scardino
authors.forename: P H
authors.initials: PH
authors.lastname: Lange
authors.forename: G H
authors.initials: GH
authors.lastname: Gasior
authors.forename: R E
authors.initials: RE
authors.lastname: Parson
authors.forename: K G
authors.initials: KG
authors.lastname: Loveland
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen