title: Comparison of total, complexed and free prostate-specific antigens and their ratios in the detection of prostate cancer in a non-screened population.
abstract: BACKGROUND
  The role of prostate-specific antigen (PSA) isoforms in the detection of prostate cancer in a non-screened population in the UK remains to be determined.
  
  
  METHODS
  Consecutive patients undergoing diagnostic transrectal ultrasound-guided biopsy of the prostate were studied. Prior to biopsy, a blood sample was obtained and total, complexed and free PSA concentrations measured.
  
  
  RESULTS
  Of the 171 patients included in the study, 103 were found to have prostate cancer. There were significant differences in total and complexed PSA concentrations and in the ratio of free-to-total PSA (all P <0.001) between patients with prostate cancer and those with benign disease. Receiver operating characteristics (ROC) curve analysis showed that the corresponding areas under the curves were similar. Restricting the analysis to the 77 patients who had total PSA concentrations between 2 and 10 micro g/L, ROC curve analysis showed that total and complexed PSA concentrations failed to discriminate between benign and malignant disease. In contrast, the areas under the ROC curve were greater for the free-to-total ratio (P = 0.033).
  
  
  CONCLUSIONS
  These results show that in patients with total PSA concentrations between 2 and 10 micro g/L, the free-to-total PSA ratio was superior to total PSA concentration in discriminating between patients with benign and malignant disease.
authors.affiliation: University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, Scotland, UK. petermcardle75@hotmail.com
authors.forename: P A
authors.initials: PA
authors.lastname: McArdle
authors.forename: M A
authors.initials: MA
authors.lastname: Pollock
authors.forename: A M
authors.initials: AM
authors.lastname: Wallace
authors.forename: D C
authors.initials: DC
authors.lastname: McMillan
authors.forename: J E
authors.initials: JE
authors.lastname: Crooks
authors.forename: M A
authors.initials: MA
authors.lastname: Underwood
mesh_terms: D015415:Biomarkers; D006801:Humans; D008297:Male; D008403:Mass Screening; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D017430:Prostate-Specific Antigen