Total and free psa ratio as a predictor of gleason score in diagnosis of prostatic carcinoma

M.Tipurić, I.Gilja, D.Tomić, J.Baranik, D.Zalihić, M.Kordić, M.Ignatkov, V.Bekavac, K.Pavlović,

Klinika za urologiju, S.K.B.Mostar


Introduction: The level of PSA is organ-specific biomarker, and non-specific marker for prostate disease. There are a lot of researches conducted to increase specificity of PSA for CAP and they should offer precise information about existence of CAP and clinical course of disease as well as directed a clinician in his diagnostic and therapy activities.

Research goal: to relate levels of PSA and f/t PSA with degree of differentiation of cell prostate carcinoma which are expressed by Gleason score. In that way it is possible to determine the significance of relation between free and total prostate specific antigen as a predictive factor for more malignant form of prostate cancer. Also, determine percentage of correlation between free and total PSA which significantlly increase possibility of existence prostate cancer for our geographic region.

Methods: Analitic prospective-retrospective study in which are involved 60 patients with CAP, who are divided into groups based on PSA level and groups based on degree of differentiation of CAP. Control group was consisted of 30 patients with diagnosis of BPH.

The data are collected by clinical examination, survey, laboratory tests, transrectal ultrasound and prostate biopsy.

Results: The level of PSA and PSA free have proved to be significant predictor of CAP and clinical behavior of disease. Height of PSA level is related with the degree of differentation of CAP. Statistically the level of f/t PSA isn’t significant predictor of differentiation of CAP. The PSA test is a test of high sensitivity but low specificity for prostate cancer. The f/t PSA test is a test of high specificity, but low sensitivity. For our geographic region optimal level of f/t PSA is 18,69%, the lower results indicate significant increases in existence of prostate cancer. The size of prostate and IPSS sum have statistically significant higher values in groups of patients with BPH.

Conclusion: The level of PSA and f/t PSA are predictors of existence prostate cancer, but PSA is also a predictor of degree of differentiation of CAP, so those two tests are significant guidelines to an urologist in his practical activity in directing diagnostic tests of patients with CAP. Optimal level of f/t PSA when an urologist mustn’t delay prostate biopsy is < 18.69%.