On the clinical usefulness of the free-to-total prostate-specific antigen ratio

S. Ciatto, T. Rubeca, R. Franceschini, C. Trevisiol, M. Confortini, G. Pontenani, C. Lombardi

Research output: Contribution to journalArticlepeer-review


The free-to-total prostate-specific antigen ratio (F/T PSA) is associated with the presence of prostate cancer and is thus used as an indicator for suspicion of prostate cancer and as a determinant for biopsy. We reviewed a recent retrospective series of 966 consecutive prostate biopsies where F/T PSA was blindly determined and did not influence biopsy indication. We simulated the association of F/T PSA with biopsy outcome and its impact as a biopsy determinant. When adopting an F/T PSA cutoff of 10%, 13%, 16% or 20% among random sextant biopsies in the 4-10 ng/mL total PSA range, the sensitivity was 15%, 37%, 55% and 72% and the specificity 89%, 80%, 64% and 44%, respectively. Using F/T PSA as a biopsy determinant, from 1.7 to 2.6 cancer biopsies would have been delayed to avoid 10 benign biopsies. As this balance is not acceptable, F/T PSA has no role as a biopsy indicator and its clinical use is questionable.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalInternational Journal of Biological Markers
Issue number1
Publication statusPublished - Jan 2006


  • F/T PSA ratio
  • Prostate cancer
  • PSA

ASJC Scopus subject areas

  • Immunology
  • Biochemistry


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