title: Predictive criteria for prostate cancer detection in men with serum PSA concentration of 2.0 to 4.0 ng/mL.
abstract: OBJECTIVE
  To assess the usefulness of measuring testosterone, free testosterone, and the free/total (f/t) prostate-specific antigen (PSA) ratio with the intention of reducing the number of unnecessary biopsies in the patients with PSA values between 2.0 and 4.0 ng/mL. Cancer detection is not rare among patients with PSA values between 2.0 and 4.0 ng/mL.
  
  
  METHODS
  A total of 171 men with serum PSA levels of 2.0 to 4.0 ng/mL were enrolled in this study. The f/t PSA ratio and total and free testosterone levels were quantified. All patients underwent transrectal ultrasound-guided biopsy. The cancer detection rate, clinical and pathologic features of the cancers detected, and the probability of cancer detection in relation to the f/t PSA ratio and total and free testosterone levels were estimated. Two-step statistical analysis was used for descriptive purposes and in the detection of cancer predictors. Statistical significance was set at P < or = 0.05.
  
  
  RESULTS
  The mean patient age was 63.3 years. Cancer was detected in 39 (22.8%) of the 171 patients. Only 15.4% of our patients had insignificant cancer. The f/t PSA ratio and total and free testosterone levels were significantly lower in the patients with prostate cancer (19.3%, 13.68 nmol/L, and 28.4 pmol/L, respectively; P < 0.001). The f/t PSA ratio and free testosterone were the strongest predictors of cancer detection (P < 0.001).
  
  
  CONCLUSIONS
  The results of our study have shown that an important number of cancers could be detected in the PSA range of 2.0 to 4.0 ng/mL. The great majority of cancers detected have the features of medically significant tumors. The combination of the f/t PSA ratio and free testosterone measurements may reveal those patients who require biopsy.
authors.affiliation: Department of Urology, Barzilai Medical Center, Ashkelon, Israel. cambell@netvision.net.il
authors.forename: Sergey
authors.initials: S
authors.lastname: Kravchick
authors.forename: Ronit
authors.initials: R
authors.lastname: Peled
authors.forename: Dov
authors.initials: D
authors.lastname: Dorfman
authors.forename: Leonid
authors.initials: L
authors.lastname: Agulansky
authors.forename: David
authors.initials: D
authors.lastname: Ben-Dor
authors.forename: Shmuel
authors.initials: S
authors.lastname: Cytron
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood*; D013739:Testosterone / Q000097:blood*
chemical_list: D013739:Testosterone; D017430:Prostate-Specific Antigen