title: Cumulative probability of prostate cancer detection in biopsy according to free/total PSA ratio in men with total PSA levels of 2.1-10.0 ng/ml at population screening.
abstract: OBJECTIVE
  The aim of this study was to investigate the cumulative probability of prostate cancer detection according to free/total prostate-specific antigen (PSA) ratio in men with PSA levels of 2.1-10.0 ng/ml and also likelihood of detecting clinically insignificant prostate cancer in population-based screening.
  
  
  METHODS
  A total of 1,277 men aged between 55 and 69 years with total PSA (tPSA) levels of 2.1-10.0 ng/ml screened in population screening in Kanazawa city and underwent systematic transrectal ultrasonography-guided prostate biopsy between 2000 and 2011 were enrolled. The cumulative probability of prostate cancer detection in biopsy according to age, serum tPSA, and free-to-total PSA (f/t PSA) ratio was investigated. The clinicopathological features of screening-detected prostate cancer were also investigated.
  
  
  RESULTS
  Of the 1,277 subjects in the study population, 320 (25.0 %) were diagnosed with prostate cancer during the observation period. The probabilities of prostate cancer detection at 3 years were 64.5, 41.2, 28.5, and 14.3 % for the men with f/t PSA ratio ≤0.08, 0.09-0.13, 0.14-0.22, and ≥0.23, respectively; the differences in probabilities of prostate cancer detection among men with different f/t PSA ratios were statistically significant. Among 320 patients, 84 (26.3 %) had favorable clinicopathological features that made them suitable for active surveillance. The f/t PSA ratio in unfavorable cancer patients was significantly lower that that in favorable cancer patients.
  
  
  CONCLUSIONS
  The present study demonstrated that the f/t PSA ratio was a strong predictor of future cancer detection and unfavorable cancerous features in prostate biopsy in men with total PSA levels of 2.1-10.0 ng/ml at population screening.
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Graduate School of Medical Science, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8640, Japan, yasukita@med.kanazawa-u.ac.jp.
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Ueno
authors.forename: Kouji
authors.initials: K
authors.lastname: Izumi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kadono
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mizokami
authors.forename: Mikio
authors.initials: M
authors.lastname: Namiki
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D055088:Early Detection of Cancer; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen