Diagnostic value of prostate-specific antigen-related parameters in discriminating prostate cancer

Background: Using the percentage (of total) of free prostate-specific antigen (PSA) in discriminating prostate cancer (CaP) from benign prostate hyperplasia (BPH) has not been fully delineated in Japanese men. To clarify the clinical significance of percent free PSA, various parameters, including total prostate volume, percent free PSA, PSA density (PSAD) and PSA density of transition zone volume (PSAT), were compared. Methods: Ninety-seven patients who had visited one of three community-based hospitals, and whose total PSA value ranged from 4 to 20 ng/mL were prospectively enrolled in this study. Fresh sera were applied to measure the percent free PSA. Results: Of the 97 patients, CaP and BPH were diagnosed in 24 (25%) and 73 patients, respectively. In discriminating Cap patients, the cutoff values of 17% for percent free PSA, 0.3 ng/mL, per cm(3) for PSAT, and 0.19 ng/mL per cm(3) for PSAD yielded specificity levels of 56, 40 and 58% at sensitivity levels of 92, 92 and 79%, respectively. As for the 65 patients with intermediate PSA, range 4-10 ng/mL, and normal digital rectal examination, the percent free PSA and total prostate volume statistically discriminated CaP patients from BPH patients. A multiple logistic regression model proved percent free PSA to be the only significant discriminating factor (P = 0.045; odds ratio, 9.06). Conclusions: This prospective study revealed percent free PSA to be a significant useful predictor in discriminating CaP from BPH in Japanese men.