Determination of an optimum cut-off point for %fPSA/tPSA to improve detection of prostate cancer

  • Vineeth G Nair Department of Pathology, Yenepoya Medical College
  • M H Shariff
Keywords: Prostate Specific Antigen, Prostatic neoplasms, ROC curve, Prostatic Hyperplasia

Abstract

Background: Total serum prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) are known to be useful in the detection of prostate carcinoma (PCa). It has been reported that %fPSA/tPSA is more accurate when it comes to distinguishing PCa from non-malignant conditions such as BPH. The recommended cut-off value of %fPSA/tPSA in western countries is 20-25%. Through this study, we aim to determine an optimum cut-off value for %fPSA/tPSA in an Indian population.Methods: This study was performed at our institution between September 2015 and August 2016. The study population included 181 patients who had prostate enlargement and who then underwent PSA based prostate cancer screening with tPSA and %fPSA/tPSA and whose diagnosis was later confirmed by histopathology. An ROC curve analysis was performed to determine sensitivity, specificity and other performance characteristics. The optimum cut-off value of %fPSA/tPSA was determined from ROC curve using Youden’s index.Result: Malignant histology was seen in 17 (9.4%) cases. ROC curve analysis of %fPSA/tPSA revealed an AUC value of 0.777. The cut-off value of %fPSA/tPSA having the optimum balance between sensitivity and specificity was found to be 12.07% (Sensitivity: 70.6%, Specificity: 84.8%, Positive predictive value: 0.324, Negative predictive value: 0.965, Positive likelihood ratio: 4.631 and Negative likelihood ratio: 0.347).Conclusion: The cut-off value of %fPSA/tPSA obtained from our study (12.07%), which was conducted on a South Indian population, is different from the cut-off values seen in western countries and in many studies conducted in western populations. DOI: 10.21276/APALM.1254

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Published
2017-09-01
Issue
Vol 4 No 4 (2017)
Section
Original Article

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