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Free and total prostate specific antigen levels and prostate cancer

DISCOVERIES (ISSN 2359-7232), 2021, October-December issue


Mediu R, Rama A, Mediu N. Screening for prostate cancer: a study on the free and total prostate specific antigen. Discoveries 2021, 9(4): e139. DOI: 10.15190/d.2021.18

Submitted: July 05, 2021; Revised: Dec. 24, 2021; Accepted: Dec. 24, 2021; Published: Dec. 31, 2021.

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Screening for prostate cancer: a study on the free and total prostate specific antigen

Ridvana Mediu (1,*), Ariol Rama (1), Naim Mediu (2)

(1) Faculty of Applied Science, Medical Science Department, University College LOGOS, Tirana, Albania

(2) General surgeon. Surgery Service, Regional Hospital, Durres, Albania

*Corresponding authorsRidvana Mediu, MSC, PhD, Department of Medical Science, Faculty of Applied Sciences, Logos University College, Tirana, Albania; Phone 042405355; Email: ridvana.mediu@kulogos.edu.al 


Background: A variety of biomarkers have been developed to monitor growth of cancerous diseases and to detect them at an early stage. Prostate-specific antigen (PSA) is a valuable prostate cancer biomarker that is now widely used for population screening, diagnosis, and monitoring of patients with prostate cancer. Other factors than prostate cancer can cause elevation of PSA levels therefore, free prostate specific antigen measurements in serum have been proposed in order to improve the specificity of laboratory identification of prostate cancer. 

Aim: The aim of our study was to evaluate the diagnostic significance of both total PSA and Free PSA in discriminating prostate cancer from other prostate diseases.

Materials and methods: Our study group consisted of 1201 males admitted at outpatient clinic aged between 35 and 84 years old (mean age 63 years). All laboratory measurements were performed on serum samples. The data were statistically analyzed by using descriptive statistics for Windows. 

Results: The mean total PSA concentration evaluated among 1038 patients was 16.17 ng/mL whereas only Free PSA concentration was evaluated in 163 serum samples and resulted in a mean value of 2.67 ng/ml. In order to calculate the correlation between total and free PSA, data among 69 /1038 patients were further analyzed through statistical program software package for data analysis.

Conclusions: Measuring serum free PSA concentrations along with PSA concentrations may provide higher accuracy for detecting prostate cancer and might eliminate unnecessary biopsies in the men with PSA of more than 4.0 ng/mL. 

Access full text of the manuscript here: 


1. Cancer Statistics Review, 1975-2013 - Previous Version - SEER Cancer Statistics Review SEER. [cited 2021 Dec 24]. Available from: https://seer.cancer.gov/archive/csr/1975_2013/index.html

2. Prostate Cancer in Albania [Internet]. World Life Expectancy. [cited 2021 Dec 22]. Available from: https://www.worldlifeexpectancy.com/albania-prostate-cancer

3. Hara M, Koyanagi Y, Inoue T, Fukuyama T. [Some physico-chemical characteristics of “ -seminoprotein”, an antigenic component specific for human seminal plasma. Forensic immunological study of body fluids and secretion. VII]. Nihon Hoigaku Zasshi Jpn J Leg Med. 1971 Jul;25(4):322–4. 

4. Li TS, Beling CG. Isolation and characterization of two specific antigens of human seminal plasma. Fertil Steril. 1973 Feb;24(2):134–44. 

5. Jung K, Brux B, Lein M, Rudolph B, Kristiansen G, Hauptmann S, et al. Molecular forms of prostate-specific antigen in malignant and benign prostatic tissue: biochemical and diagnostic implications. Clin Chem. 2000 Jan;46(1):47–54. 

6. Jacobsen SJ, Bergstralh EJ, Guess HA, Katusic SK, Klee GG, Oesterling JE, et al. Predictive properties of serum-prostate-specific antigen testing in a community-based setting. Arch Intern Med. 1996 Nov 25;156(21):2462–8. 

7. Allan GM, Chetner MP, Donnelly BJ, Hagen NA, Ross D, Ruether JD, et al. Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks). Can Urol Assoc J J Assoc Urol Can. 2011 Dec;5(6):416–21. 

8. Haythorn MR, Ablin RJ. Prostate-specific antigen testing across the spectrum of prostate cancer. Biomark Med. 2011 Aug;5(4):515–26. 

9. Meyer A, Jung K, Lein M, Rudolph B, Schnorr D, Loening SA. Factors influencing the ratio of free to total prostate-specific antigen in serum. Int J Cancer. 1997 Dec 19;74(6):630–6. 

10. Ito K, Yamamoto T, Ohi M, Kurokawa K, Suzuki K, Yamanaka H. Free/Total PSA ratio is a powerful predictor of future prostate cancer morbidity in men with initial PSA levels of 4.1 to 10.0 ng/mL. 2003;5. 

11. Oesterling JE, Jacobsen SJ, Klee GG, Pettersson K, Piironen T, Abrahamsson PA, et al. Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios. J Urol. 1995 Sep;154(3):1090–5. 

12. Filella X, Alcover J, Molina R, Rodríguez A, Carretero P, Ballesta AM. Clinical evaluation of free PSA/total PSA (prostate-specific antigen) ratio in the diagnosis of prostate cancer. Eur J Cancer Oxf Engl 1990. 1997 Jul;33(8):1226–9. 

13. Huang JG, Campbell N, Goldenberg SL. PSA and beyond: Biomarkers in prostate cancer. :8. 

14. Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998 May 20;279(19):1542–7. 

15. Toren P, Wong L-M, Timilshina N, Alibhai S, Trachtenberg J, Fleshner N, et al. Active surveillance in patients with a PSA >10 ng/mL. Can Urol Assoc J J Assoc Urol Can. 2014 Sep;8(9–10):E702–7. 

16. Gandaglia G, Albers P, Abrahamsson P-A, Briganti A, Catto JWF, Chapple CR, et al. Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer: The European Association of Urology Position in 2019. Eur Urol. 2019 Aug;76(2):142–50. 

17. Battikhi MNG. Age-specific reference ranges for prostate-specific antigen (PSA) in Jordanian patients. Prostate Cancer Prostatic Dis. 2003 Sep 1;6(3):256–60. 

18. Vashi AR, Oesterling JE. Percent free prostate-specific antigen: entering a new era in the detection of prostate cancer. Mayo Clin Proc. 1997;72 4:337–44. 

19. DeAntoni EP, Crawford ED, Oesterling JE, Ross CA, Berger ER, McLeod DG, et al. Age- and race-specific reference ranges for prostate-specific antigen from a large community-based study. Urology. 1996 Aug;48(2):234–9. 

20. Anderson JR, Strickland D, Corbin D, Byrnes JA, Zweiback E. Age-specific reference ranges for serum prostate-specific antigen. Urology. 1995 Jul;46(1):54–7. 

21. Martínez-Piñeiro L, Tabernero A, Contreras T, Madero R, Lozano D, López-Tello J, et al. Determination of the percentage of free prostate-specific antigen helps to avoid unnecessary biopsies in men with normal rectal examinations and total  prostate-specific antigen of 4-10 ng/ml. Eur Urol. 2000 Mar;37(3):289–96. 

22. Gion M, Mione R, Barioli P, Barichello M, Zattoni F, Prayer-Galetti T, et al. Percent free prostate-specific antigen in assessing the probability of prostate cancer under optimal analytical conditions. Clin Chem. 1998 Dec;44(12):2462–70. 

23. Benson MC, Whang IS, Olsson CA, McMahon DJ, Cooner WH. The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol. 1992 Mar;147(3 Pt 2):817–21. 

24. Nogueira L, Corradi R, Eastham JA. Prostatic specific antigen for prostate cancer detection. Int Braz J Urol Off J Braz Soc Urol. 2009 Oct;35(5):521–9; discussion 530-532. 

25. Woodrum DL, Brawer MK, Partin AW, Catalona WJ, Southwick PC. Interpretation of free prostate specific antigen clinical research studies for the detection of prostate cancer. J Urol. 1998 Jan;159(1):5–12. 

26. Mikolajczyk SD, Catalona WJ, Evans CL, Linton HJ, Millar LS, Marker KM, et al. Proenzyme forms of prostate-specific antigen in serum improve the detection of prostate cancer. Clin Chem. 2004 Jun;50(6):1017–25. 

27. Loeb S, Catalona WJ. The Prostate Health Index: a new test for the detection of prostate cancer. Ther Adv Urol. 2014 Apr;6(2):74–7.

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