title: PSA-related markers in the detection of prostate cancer and high-grade disease in the contemporary era with extended biopsy.
abstract: OBJECTIVE
  To determine the relationship of total PSA (tPSA), percent free PSA (%fPSA), and complexed PSA (cPSA) with prostate cancer detection and the diagnosis of poorly-differentiated cancers in the contemporary era.
  
  
  METHODS
  We retrospectively reviewed the clinical and pathological records of 292 men who met the following inclusion criteria: (1) tPSA 2.5 to 10 ng/ml; (2) initial biopsy only; (3) extended biopsy scheme (>or=10 peripheral zone cores); (4) no previous prostate surgeries. The ability of PSA-related markers to detect cancer was determined by area under the receiver operating characteristics curve analysis (AUC-ROC). Various clinically relevant % fPSA cutoffs and cPSA ranges were analyzed to determine the association with poorly-differentiated cancers.
  
  
  RESULTS
  Cancer was detected in 126 (43%) men, with mean Gleason score of 7. The cancer detection rates for various cutoffs of tPSA, cPSA and % fPSA were very similar. On ROC analysis for cancer diagnosis, the AUCs for tPSA, % fPSA, and cPSA were 0.53, 0.54, and 0.52, respectively. Men with % fPSA <15 were more likely to have poorly-differentiated cancer than those with % fPSA >or=15 (66% vs. 41%, P < 0.005). Similarly, cPSA ranges (2-4, 4.1-6, and >6) were associated with the detection of poorly-differentiated cancers (37%, 57%, and 80% P < 0.003).
  
  
  CONCLUSIONS
  With the use of extended prostate sampling in the contemporary screening population, the addition of cPSA and % fPSA does not enhance the diagnostic performance of tPSA. However, the significant association between cPSA and poorly-differentiated cancers suggests that this may be a more useful initial test for prostate cancer screening.
authors.affiliation: Division of Urology, Albany Medical College and Stratton VA Medical Center, Albany, NY 12208, USA.
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.forename: Hugh A G
authors.initials: HA
authors.lastname: Fisher
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Kaufman
authors.forename: Diana
authors.initials: D
authors.lastname: Voskoboynik
authors.forename: Tipu
authors.initials: T
authors.lastname: Nazeer
authors.forename: Badar M
authors.initials: BM
authors.lastname: Mian
mesh_terms: D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen