Significance of Serum Free Prostate Specific Antigen in the Screening of Prostate Cancer |
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Authors: | Eiji Higashihara Kikuo Nutahara Miho Kojima Takatsugu Okegawa Ichiro Miura Akiomi Miyata Moriaki Kato Hajime Sugisaki Takeshi Tomaru |
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Affiliation: | aDepartment of Urology, Kyorin University, School of Medicine, Mitaka, and SRL Incorporated, Tachikawa, Tokyo, Japan. |
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Abstract: | PurposeThe significance of serum free prostate specific antigen (PSA) in the screening of prostate cancer was examined.Materials and MethodsA prospective clinical trial was conducted on 701 male volunteers 50 years old or older. Serum free PSA was determined and biopsies were performed if PSA was greater than 4 ng./ml. or if digital rectal examination was suspicious for cancer.ResultsOf the men 187 (27 percent) had a PSA of greater than 4 ng./ml. (11 percent) and/or a suspicious digital rectal examination (19 percent). Of 116 biopsies performed in the 701 men cancer was detected in 13 (1.9 percent). PSA detected more tumors (12 of 13, 92 percent) than digital rectal examination (9, 69 percent). Receiver operating characteristic analysis showed that the optimal free PSA-to-PSA ratio (free PSA ratio) was 12 percent. The positive predictive value for cancer according to PSA with free PSA ratio (50 percent, 10 cancers in 20 biopsies) was significantly greater (p = 0.0473) than that according to PSA alone (24 percent, 12 cancers in 50 biopsies), which indicated that 30 of 50 biopsies were avoided with only 2 cancers missed when PSA and free PSA were used for biopsy indication.ConclusionsFree PSA determination might eliminate unnecessary biopsies in men with a PSA of more than 4 ng./ml. with minimal missed cancers. |
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