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Abstract
Objective: To evaluate whether the free‐to‐total prostate‐specific antigen (F/T‐PSA) ratio can be used to differentiate between stage pT2 and pT3 prostate cancer.
Material and Methods: A total of 176 consecutive patients from the Göteborg Screening Study (median T‐PSA 4.2 ng/ml) who underwent radical prostatectomy (without neoadjuvant hormonal therapy) were included in the study. The pT stage was correlated with classical risk factors such as T‐PSA and Gleason sum and the impact of the F/T‐PSA ratio was evaluated.
Results: A total of 42/176 patients (23.9%) had stage pT3 prostate cancer. Patients with an F/T‐PSA ratio in the lowest quartile (<10.7%) had extracapsular tumor growth in 46.5% of cases, compared to 16.7% for those with an F/T‐PSA ratio >10.7% (p = 0.0002). Patients with high‐risk features (T‐PSA >10 ng/ml or Gleason sum ≥7) had a high risk (54–60%) for stage pT3 prostate cancer. In low‐risk patients, the subgroup with an F/T‐PSA ratio <10.7% had a risk of 37.0%, compared to only 13.3% for those with a ratio of >10.7% (p = 0.0092).
Conclusions: In patients with low‐risk early‐stage prostate cancer, the F/T‐PSA ratio provides statistically significant, independent and clinically relevant preoperative information about the risk of extracapsular tumor growth.