title: The value of percentage free prostate specific antigen (PSA) in the detection of prostate cancer among patients with intermediate levels of total PSA (4.0-10.0 ng/mL) in Nigeria.
abstract: OBJECTIVE
  To assess the value of percentage free prostate-specific antigen (%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate total PSA level (4-10 ng/mL), and to show if the optimum threshold for biopsy is different from Caucasian values when the widely used (six-core, digitally directed) prostate biopsy protocol in Nigerians is applied.
  
  
  METHODS
  The study included 105 patients aged >50 years, with a palpably benign prostate gland and intermediate levels of total PSA (4-10 ng/mL). These patients had a free PSA assay and a transrectal digitally directed six-core biopsy of the prostate. The %fPSA was calculated and the optimum threshold value for detecting prostate cancer was determined.
  
  
  RESULTS
  The mean (SD) age of the patients was 64.4 (6.6) years and their mean (SD) total PSA level was 6.6 (1.7) ng/mL. Of these men 14 (13.3%) had cancer of the prostate detected by the prostate biopsy. The %fPSA level related directly to sensitivity values but inversely to the specificity and the positive predictive values. The best threshold of %fPSA for detecting cancer in these men was <40%, with a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70% (P < 0.05).
  
  
  CONCLUSIONS
  In evaluating Nigerian patients with a palpably benign prostate gland and within the intermediate total PSA range, when digitally directed biopsy protocol is adopted, a %fPSA threshold of <40% will detect significant percentage of those with prostate cancer, with a minimal number of unnecessary biopsies. This value differs from that reported in western studies in which transrectal ultrasonography-directed biopsy was used.
authors.affiliation: Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: E V
authors.initials: EV
authors.lastname: Ezenwa
authors.affiliation: Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: K H
authors.initials: KH
authors.lastname: Tijani
authors.affiliation: Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: E A
authors.initials: EA
authors.lastname: Jeje
authors.affiliation: Department of Chemical Pathology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: O O
authors.initials: OO
authors.lastname: Soriyan
authors.affiliation: Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: M A
authors.initials: MA
authors.lastname: Ogunjimi
authors.affiliation: Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: R W
authors.initials: RW
authors.lastname: Ojewola
authors.affiliation: Department of Chemical Pathology, Lagos University Teaching Hospital, Lagos, Nigeria.
authors.forename: O I
authors.initials: OI
authors.lastname: Ajie
authors.affiliation: Urology Department, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt.
authors.forename: A R
authors.initials: AR
authors.lastname: El-Nahas
keywords: %fPSA, percentage free PSA; AUC, area under the curve; Free PSA; Intermediate PSA range; Nigeria; PPV, positive predictive value; Prostate cancer; ROC, receiver operator characteristic; tPSA, total PSA