DOES FREE TO TOTAL RATIO OF PROSTATE-SPECIFIC ANTIGEN ALTER DECISION-MAKING ON PROSTATIC BIOPSY

Objectives, For patients with prostate specific antigen (PSA) values o f 4-10 ng/mL, some urologists perform prostatic biopsies depending upo n the findings of digital rectal examination (DRE) and transrectal ult rasonography (TRUS), and others perform biopsies on most of these men regardless of the findings of DRE and TRUS. The purpose of this study was to examine whether the information given by the measurement of the ratio of free to total (FIT] PSA can alter decision-making on prostat ic biopsy. Methods. One hundred and two (102) men with PSA values betw een 4 and 10 ng/mL, were included in this study. All men were examined with DRE and TRUS; a F/T PSA ratio was also measured, and six prostat ic biopsies were taken from each patient. Results. in 102 men who were biopsied, 22 [21.5%) prostatic carcinomas were identified. Among thes e 22 cancer patients, 13 had abnormal findings in DRE and/or TRUS and would have been biopsied and diagnosed anyway. If we use only the F/T PSA ratio (cut-off value 0.20) to decide whom to biopsy, we would have diagnosed 16/22 cancers; the difference between these two procedures was not statistically significant (P = 0.17). If we decide to biopsy t hose patients who have abnormal findings in DRE and/or TRUS and those who have a F/T PSA ratio <0.20, we would diagnose 20/22 cancers (P = 0 .05) and at the same time, reduce the unnecessary biopsies from 80 to 41 (48%). With a PSA value between 4 and 10 ng/mL and no findings in D RE and TRUS and at the same time with a FTT PSA ratio greater than or equal to 0.20, we would have to perform biopsies in 20.5 men to find o ne cancer. On the other hand, in patients with suspicious findings in DRE and/or TRUS and a FTT PSA ratio <0.20, in every two men that we bi opsy we would find one cancer. Conclusion. We believe that among patie nts with PSA values between 4 and 10 ng/mL after performing DRE and TR US, the additional information of F/T PSA ratio can help since it incr eases the number of cancers detected and reduces the number of unneces sary biopsies. Copyright 1996 by Elsevier Science Inc.