Utilidad clínica de la ratio PSA libre / PSA total en el diagnóstico precoz del cáncer de próstata

Mª. PILAR LAGUNA PES, CARLOS GUINDA SEVILLANO, ANDRÉS ZAZO ROMOJARO, ANABELLA GARCÍA LUZÓN, JAIME BORREGO HERNANDO, ALFONSO GIMENO COLLADO, JOAQUÍN DOMÍNGUEZ

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Archivos Españoles de Urología ›› 2000, Vol. 53 ›› Issue (4) : 333-341.
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Utilidad clínica de la ratio PSA libre / PSA total en el diagnóstico precoz del cáncer de próstata

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OBJECTIVES: To determine the clinicalutility of free / total PSA ratio and PSA density in the earlydiagnosis of prostate cancer (patients with serum PSAbetween 4 and 10 ng/ml) and to determine the diffferences,if any, in the free / total PSA ratio in patients with cancerand those with benign prostatic hyperplasia (BPH).METHODS: A prospective and descriptive study wasconducted on 61 patients with low grade obstructivesymptoms and total serum PSA between 4 and 10 ng/ml(group 1), and 42 patients who underwent prostate surgeryand had an anatomopathologically confirmed diagnosisof BPH (group 2).Free and total PSA were determined, as well as prostatevolume by transrectal US, in all cases. Prostate biopsywas performed in all patients with a total PSA valuebetween 4-10 ng/ml. The sensitivity, specificity, positiveand negative prognostic values of free / total PSA ratioand PSA density were analyzed.RESULTS: The mean age of the patients in group 1 was67.7 years and 68.3 years in group 2. The mean prostatevolume by US was 55.2 and 47.1, respectively (n.s.). Themean total PSA was 6.39 ng/ml for group 1 and 5.73ng/ml for group 2 (n.s.). No significant difference wasfound between the mean free PSA values of both groups.However, the free / total PSA ratio and PSA density weresignificantly different (p< 0.000). In group 1 (total PSA 4-10 ng/ml), prostate biopsy was positive in 32.8% of thepatients. In this group of patients, there were no significantdifferences in the parameters analyzed.Application of different cutoffs for both tests showed ahigher clinical utility for the 0.24-0.30 range.CONCLUSIONS: At similar mean prostate volume andmean total PSA, significant differences were found in thefree / total PSA ratio and PSA density of patients submittedto surgery for BPH and those with a total PSA value of 4-10 ng/ml. However, these results were not observed whenpatients with PSA of 4-10 ng/ml were analyzed for presenceor absence of evidence of malignancy in the prostatebiopsy.

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Prostate-specific antigen / PSA / Total PSA / Free PSA / PSA density / Clinical utility

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Mª. PILAR LAGUNA PES , CARLOS GUINDA SEVILLANO , ANDRÉS ZAZO ROMOJARO , ANABELLA GARCÍA LUZÓN , JAIME BORREGO HERNANDO , ALFONSO GIMENO COLLADO , JOAQUÍN DOMÍNGUEZ. Utilidad clínica de la ratio PSA libre / PSA total en el diagnóstico precoz del cáncer de próstata. Archivos Españoles de Urología. 2000, 53(4): 333-341

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