The effect of percentage free prostate-specific antigen (PSA) level on the prostate cancer detection rate in a screening population with low PSA levels


Alexandre E. Pelzer, Department of Urology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.



To evaluate the prostate cancer detection rate at low total prostate-specific antigen (tPSA) ranges of 2.6–4 and 4.1–10 ng/mL, according to different percentage free (f/t) PSA levels in a screening population.


In all, 1809 consecutive screening volunteers with a tPSA level of 2.6–10.0 ng/mL were assessed. Ten systematic ultrasonography-guided prostate biopsies and, since 2000, an additional five Doppler-enhanced targeted biopsies were taken on the basis of age-specific tPSA reference ranges. We analysed the detection rate of prostate cancer according to f/tPSA ranges of 0–9%, 10–14%, 15–18% and >18%.


The detection rates for the subgroups with tPSA levels of 2.6–4.0 and 4.1–10.0 ng/mL were 20.2% and 27.0%, respectively. The cancer detection rate in the first group (2.6–4.0 ng/mL) at 0–10% fPSA was 22.9%, and that in the second group (4.1–10.0 ng/mL) at 0–10% was 36.9%. There were significant differences between these groups. If the f/tPSA was 10–15%, the cancer detection rate for the two groups were 22.6% and 32.5%, respectively (P < 0.05). There was no statistically significant difference in the cancer detecting rates at an f/tPSA of 15–18% or >18%.


There is a statistically significantly higher cancer detection rate when the f/tPSA is <15% than in groups of men with a f/tPSA of >15% in screening population assessed primarily using tPSA level.