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. 2014 Nov;30(11):545-50.
doi: 10.1016/j.kjms.2014.03.008. Epub 2014 Apr 20.

The cutoff level of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: a validation study on a Turkish patient population in different age categories

Bulent Erol  1 , Murat Tolga Gulpinar  2 , Gurdal Bozdogan  3 , Seyma Ozkanli  4 , Kadir Onem  5 , Görkem Mungan  6 , Sibel Bektas  7 , Husnu Tokgoz  3 , Bulent Akduman  3 , Aydin Mungan  3
Affiliations

The cutoff level of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: a validation study on a Turkish patient population in different age categories

Bulent Erol et al. Kaohsiung J Med Sci. 2014 Nov.

Abstract

We investigated an optimal cutoff level of free/total PSA ratios (f/t PSA) in predicting prostate cancer in different age groups, focusing on the avoidance of unnecessary prostate biopsies. A total of 4955 men were enrolled into the study. Serum tPSA, fPSA, and f/t PSA ratios were determined for the study population. All males who had suspicious digital rectal examination and tPSA > 4 ng/mL underwent transrectal ultrasonography-guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by plotting the sensitivity versus 1-specificity for the f/t PSA ratio. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were obtained using various f/t PSA ratio cutoffs for different age groups. There were 657 patients with a PSA level of 4-10 ng/mL. According to sensitivity and specificity f/t% PSA cutoff points were determined to be 10%, 15%, 15%, and 10% in 50-59 years, 60-69 years, >70 years, and all ages categories, respectively, in patients with initial PSA level of 4-10 ng/mL. f/t PSA ratio had an area under the curve (AUC) value of 0.81 (95% confidence level: 0.80-0.82) for all age groups in detecting prostate cancer. f/t PSA ratio has an AUC value of 0.669 (0.632-0.705) in detecting prostate cancer among patients with a PSA level of 4-10 ng/mL. Ten percent of f/t PSA ratio had the highest specificity with PLR and 30% f/t PSA ratio had the highest sensitivity with lower NLR in the all-age categories. The current study shows that the use of f/t PSA ratio in patients with PSA levels of 4-10 ng/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. The age-related changes warrant further investigation in a large, multicentric, and multinational population to improve the clinical use of f/t PSA cutoffs.

Keywords: Prostate cancer; Sensitivity; Specificity; f/T PSA ratios.

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Figures

Figure 1
Figure 1
Receiver operating characteristic curve of f/t prostate‐specific antigen (PSA) ratio for all age groups in 4955 patients.
Figure 2
Figure 2
Performance of f/t prostate‐specific antigen (PSA) ratio in 657 patients with a PSA level of 4–10 ng/mL.
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