title: The relation of prostate biopsy results and ratio of free to total PSA in patients with a total PSA between 4-20 ng/mL.
abstract: OBJECTIVE
  In this study our aim was to investigate the efficacy of free to total PSA ratio in discrimination of benign prostate hyperplasia and prostate cancer.
  
  
  METHODS
  A total of 194 patients, 52 to 82 years old (mean 66.06 +/- 0.47 years) with PSA levels between 4 to 20 ng/mL were included into this study. Each patient underwent sextant prostate biopsy under transrectal ultrasound guidance. The patients were divided into two groups as PSA 4-10 and 10-20 ng/mL. Patients with benign and malign results were compared with respect to age, total PSA level, free PSA level and free/total (f/t) PSA ratio.
  
  
  RESULTS
  Biopsies revealed prostate cancer in 16 of 130 patients (12.3%) with serum PSA 4-10 ng/mL and in 10 of 64 patients (15.6%) with serum PSA 10-20 ng/ml. In both PSA groups free PSA and f/t PSA levels were statistically significant, where total PSA levels were not. In patients with 4-20 ng/mL total PSA levels and a cut off level of < 0.18 for f/t PSA, the sensitivity, specificity and positive predictive value for prostate cancer were 88.5%, 53.6% and 20.4% respectively.
  
  
  CONCLUSIONS
  Higher levels of PSA suggest prostate cancer, but still additional parameters are needed for patients with PSA 4-20 ng/mL, such as free PSA and f/t PSA. Although a cut off level of < 0.18 for f/t PSA seems to be the most accurate one to discriminate benign and malign diseases further studies on larger groups of patients are needed.
authors.affiliation: SSK Izmir Hospital, Urology Department, Turkey.
authors.forename: C O
authors.initials: CO
authors.lastname: Yeniyol
authors.forename: G
authors.initials: G
authors.lastname: Bozkaya
authors.forename: A
authors.initials: A
authors.lastname: Cavuşoğlu
authors.forename: M
authors.initials: M
authors.lastname: Arslan
authors.forename: B
authors.initials: B
authors.lastname: Karaca
authors.forename: A R
authors.initials: AR
authors.lastname: Ayder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen