Is Free/Total PSA Predictive of Pathological Stage and Gleason Score in Patients with Prostate Cancer and Serum PSA ≤10 ng/ml?

Introduction: To evaluate whether percent free prostate-specific antigen (%-fPSA) could be predictive of pathological stage and Gleason score in patients with prostate cancer (PCa) and serum PSA of 10 ng/ml or less. Materials and Methods: In 100 patients with total PSA ≤ 10 ng/ ml who underwent radical retropubic prostatectomy as primary treatment of PCa, %-fPSA levels in organ-confined vs. non-organ-confined PCa and in patients with Gleason score ≤/>7 were compared. Results: 32 patients had an organ-confined and 68 a locally advanced PCa. Median %-fPSA level was 15%; Gleason score was <7 in 49 patients, equal to 7 in 40 and >7 in 11. Median %-fPSA levels in PCa with Gleason score ≤/>7 was 14, 15.5 and 15%, respectively. Multiple logistic regression analysis did not show any correlation between %-fPSA in organ-confined vs. non-organ-confined PCa (p = 0.4991) either between Gleason score <7 vs. equal to 7 (p = 0.588) or >7 (p = 0.547). Conclusions: %-fPSA cut-off does not seem to be useful for preoperative staging of patients with PCa and serum PSA ≤ 10 ng/ml. Copyright © 2006 S. Karger AG.