THE ROLE OF FREE TOTAL PROSTATE-SPECIFIC ANTIGEN RATIO IN THE PREDICTION OF FINAL PATHOLOGICAL STAGE FOR MEN WITH CLINICALLY LOCALIZED PROSTATE-CANCER/

Objectives, The combined use of total prostate-specific antigen (PSA), clinical stage, and Gleason score accurately predicts final pathologi c stage for men with clinically localized prostate cancer. Recently, t he free/ total PSA ratio has been proposed as an adjunct for early det ection of prostate cancer. We examined the association between free/to tal PSA and pathologic stage. Methods. In a prospective study, 301 con secutive men with clinically localized prostate cancer (average age 58 .8 years, range 45-72) underwent a staging pelvic lymphadenectomy and radical prostatectomy. Total PSA and free PSA were measured from preop erative sera. Pathologic stage was determined as organ-confined (OC, n = 169), capsular penetration (CP+, n = 108), seminal vesicle involvem ent (SV+, n = 13) and lymph node involvement (LN+, n = II). Results. O verall, 292/301 (97%) of the free/total PSA values were <25%, and thus suspicious for prostate cancer. Combination of total PSA, Gleason sco re, and clinical stage predicted well OC (P = 0.00001) and LN+ (P = 0. 023); whereas, replacing total PSA with free/total PSA ratio did not i mprove the prediction of OC (P = 0.0007) nor LN+ (P = 0.03). Conclusio ns. The free/total PSA ratio cutoff point of 25% had high sensitivity for prostate cancer among a group of men with clinically localized dis ease. The free/total PSA ratio did not significantly improve the predi ction of pathologic stage provided by total PSA when used alone or in combination with Gleason score and clinical stage. These preliminary d ata demonstrate that free/total PSA levels provide no additional infor mation for pathologic stage prediction when combined with Gleason scor e and clinical stage in men with clinically localized prostate cancer. Copyright 1996 by Elsevier Science Inc.