title: Comparison of several combinations of free, complexed, and total PSA in the diagnosis of prostate cancer in patients with urologic symptoms.
abstract: OBJECTIVE
  To compare the diagnostic efficacy of prostate-specific antigen (PSA) and the PSA fractions (free PSA [fPSA] and complexed PSA [cPSA]) in the differential diagnosis between prostate cancer and benign prostatic hyperplasia.
  
  
  METHODS
  We measured the serum levels of total PSA (tPSA; Hybritech and Bayer), fPSA (Hybritech), and cPSA (Bayer) in 72 patients with prostate cancer and 128 patients with benign prostatic hyperplasia.
  
  
  RESULTS
  Receiver operating characteristic curves were used for comparison of these tests. The greatest area under the curve was observed for the fPSA/cPSA ratio and the fPSA/tPSA ratio (0.757 and 0.754, respectively). The substitution of the fPSA/tPSA ratio with the fPSA/cPSA ratio in the diagnostic scheme of prostate cancer improved the diagnostic accuracy, with similar sensitivity and an increment in specificity (41% versus 45%).
  
  
  CONCLUSIONS
  The fPSA/cPSA ratio ensures a reduction in negative biopsies in the PSA gray zone. We suggest substituting the fPSA/tPSA ratio with the fPSA/cPSA ratio for patients with a PSA level between 4 and 10 ng/mL.
authors.affiliation: Department ofClinical Biochemistry, IDIBAPS, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Filella
authors.forename: David
authors.initials: D
authors.lastname: Truan
authors.forename: Joan
authors.initials: J
authors.lastname: Alcover
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Rafael
authors.initials: R
authors.lastname: Molina
authors.forename: Pilar
authors.initials: P
authors.lastname: Luque
authors.forename: Francisca
authors.initials: F
authors.lastname: Coca
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Ballesta
mesh_terms: D000368:Aged; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010173:Palpation; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D012372:ROC Curve; D012044:Regression Analysis; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen