title: On the clinical usefulness of the free-to-total prostate-specific antigen ratio.
abstract: The free-to-total prostate-specific antigen ratio (F/T PSA) is associated with the presence of prostate cancer and is thus used as an indicator for suspicion of prostate cancer and as a determinant for biopsy. We reviewed a recent retrospective series of 966 consecutive prostate biopsies where F/T PSA was blindly determined and did not influence biopsy indication. We simulated the association of F/T PSA with biopsy outcome and its impact as a biopsy determinant. When adopting an F/T PSA cutoff of 10%, 13%, 16% or 20% among random sextant biopsies in the 4-10 ng/mL total PSA range, the sensitivity was 15%, 37%, 55% and 72% and the specificity 89%, 80%, 64% and 44%, respectively. Using F/T PSA as a biopsy determinant, from 1.7 to 2.6 cancer biopsies would have been delayed to avoid 10 benign biopsies. As this balance is not acceptable, F/T PSA has no role as a biopsy indicator and its clinical use is questionable.
authors.affiliation: Centre for Oncological Study and Prevention, Florence, Italy. s.ciatto@cspo.it
authors.forename: S
authors.initials: S
authors.lastname: Ciatto
authors.forename: T
authors.initials: T
authors.lastname: Rubeca
authors.forename: R
authors.initials: R
authors.lastname: Franceschini
authors.forename: C
authors.initials: C
authors.lastname: Trevisiol
authors.forename: M
authors.initials: M
authors.lastname: Confortini
authors.forename: G
authors.initials: G
authors.lastname: Pontenani
authors.forename: C
authors.initials: C
authors.lastname: Lombardi
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000175:diagnosis; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen