title: Evaluation of free-to-total prostate specific antigen (F/T PSA), prostate specific antigen density (PSAD) and (F/T)/PSAD sensitivity on reduction of unnecessary prostate biopsies for patients with PSA in gray zone.
abstract: OBJECTIVE
  We evaluated the influence of ratio between free-to-total prostate specific antigen (F/T PSA) and prostate specific antigen density (PSAD)-(F/T)/PSAD on reduction of unnecessary prostate biopsies in grey zone (prostate specific antigen (psa) value 4.0-10.0 ng/ml).
  
  
  METHODS
  The study included 108 patients. For all patients serum total PSA (T PSA), free PSA (F PSA), F/T PSA and PSAD were analyzed. The group was divided due to the prostate volume into: entire group (regardless the prostate VOL-Group 1) and group with prostate VOL<40 (Group 2).
  
  
  RESULTS
  Seventy five patients were diagnosed with benign prostatic hyperplasia (BPH) and 33 with prostate cancer (CaP). F/T PSA and (F/T)/PSAD showed significantly lower values in patients with CaP versus those with BPH, while PSAD had significantly higher values. For the cutoff values of 1.12 for (F/T)/PSAD, we found sensitivity to be 67% and specificity 60%, and the (AUC) 0.701. For patients with VOL<40, statistical significance remained with AUC of 0.732 (p=0.003), cutoff was 0.82, and with sensitivity 77% and specificity 68%.
  
  
  CONCLUSIONS
  Most significant prostate carcinoma predictors were PSAD and (F/T)/PSAD, where we proposed that patients with (F/T)/PSAD values below 1.49 ± 0.94 and PSAD values above 0.17±0.06 should be included for biopsy.
authors.forename: Borivoj
authors.initials: B
authors.lastname: Milkovic
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dzamic
authors.forename: Tomislav
authors.initials: T
authors.lastname: Pejcic
authors.forename: Boris
authors.initials: B
authors.lastname: Kajmakovic
authors.forename: Dejan
authors.initials: D
authors.lastname: Nikolic
authors.forename: Dragana
authors.initials: D
authors.lastname: Cirovic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Knezevic
authors.forename: Dragana
authors.initials: D
authors.lastname: Dzamic
authors.forename: Jovan
authors.initials: J
authors.lastname: Hadzi-Djokic
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000473:pathology; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen