title: Cumulative prostate cancer risk assessment with the aid of the free-to-total prostate specific antigen ratio.
abstract: OBJECTIVE
  To evaluate the cumulative risk of having a prostate cancer diagnosis in a repeated screening situation in relation to the free-to-total prostate specific antigen ratio (F/T-PSA).
  
  
  METHODS
  The present study includes 1385 men (aged 50-70 years) who underwent prostate biopsy for the first time in the screening program that started in 1995. In case of a benign finding, the men have been followed biennially and new biopsies performed in case of persistently elevated PSA. The cumulative risk to be diagnosed with prostate cancer until July 1, 2002 was calculated by the Kaplan-Meier method and comparison was made between different levels of T-PSA and F/T-PSA ratios.
  
  
  RESULTS
  Of 2129 biopsies 469 showed cancer. The cumulative 5-year risk to be diagnosed with prostate cancer was significantly dependent of the F/T-ratio. The risk for men with a T-PSA of 3-5.99 g/ml was 16% [6-25%] for those who had a ratio of >30% and 44% [34-60%] for those with a ratio of <10%. The corresponding difference for patients with a T-PSA of 6-9.99 g/ml was even more pronounced: 21% [0-42%] vs. 80% [64-96%].
  
  
  CONCLUSIONS
  By completing the T-PSA measurement with the F/T-PSA ratio it is possible to significantly better assess the cumulative prostate cancer risk within the next five years (without the aid of further urological work-up).
authors.affiliation: Department of Urology, Sahlgrens University Hospital, S41345 Göteborg, Sweden. gunnar.aus@vgregion.se
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Charlotte
authors.initials: C
authors.lastname: Becker
authors.forename: Stefan
authors.initials: S
authors.lastname: Franzén
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.forename: Pär
authors.initials: P
authors.lastname: Lodding
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment
chemical_list: D017430:Prostate-Specific Antigen