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Values for free/total prostate-specific antigen ratio as a function of age: necessity of reference validation in a Turkish population

Abstract Background: The aim of this study was to evaluate age-related changes in free/total prostate-specific antigen (f/t PSA) ratio, focusing on the avoidance of unnecessary prostate biopsies. Methods: A total of 898 men aged 30–88 years without a history of prostate surgery and disease were enrolled into the study. Serum tPSA, fPSA and f/t PSA ratios were determined for the study population and for different age categories. 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 vs. 1–specificity for the f/t PSA ratio. The sensitivity and specificity were obtained using different f/t PSA ratio cutoffs for different age groups. Results: Prostate cancer was detected in 63 patients (7%). Age-specific cutoffs were determined according to likelihood ratios at the levels of 10%, 15% and 15% f/t PSA ratio for ages 50–59, 60–69 and ≥70 years, respectively. However, a single cutoff of 10% is recommended across all age ranges (positive likelihood ratio 2.36). ROC curves demonstrated that the area under the curve (AUC) was significant for all patients with initial PSA of 4–10 ng/mL (AUC 0.703–0.796), except for the ≥70-year age group (AUC 0.549). Conclusions: The current study showed 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. f/t PSA levels may show dissimilarities according to age and ethnicity, so further studies are warranted to identify this relationship. Clin Chem Lab Med 2007;45:912–6.