Percentage of free PSA in black versus white men for detection and staging of prostate cancer: A prospective multicenter clinical trial

William J. Catalona*, Alan W. Partin, Kevin M. Slawin, Cathy K. Naughton, Michael K. Brawer, Robert C. Flanigan, Jerome P. Richie, Anup Patel, Patrick C. Walsh, Peter T. Scardino, Paul H. Lange, Jean B. Dekernion, Paula C. Southwick, Kathleen G. Loveland, Robert E. Parson, Gail H. Gasior

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Objectives. In predominately white populations, measurement of the percentage of free prostate-specific antigen (%fPSA) has been shown to enhance the specificity of total PSA testing for prostate cancer while maintaining high sensitivity and to aid in prostate cancer staging. This study evaluated whether the %fPSA cutoff that maintained a 95% sensitivity in a white population yielded the same sensitivity and specificity in a black population and whether %fPSA was useful in predicting postoperative pathologic features in blacks.Methods. We evaluated 647 white and 79 black men, prospectively enrolled at prostate cancer screening and surgical referral centers. Subjects were 50 to 75 years old with digital rectal examination findings that were not suspicious for prostate cancer and total PSA values between 4.0 and 10.0 ng/mL. All had undergone needle biopsy of the prostate. Hybritech's Tandem total and free PSA assays were used.Results. Ninety-five percent sensitivity was attained with a %fPSA cutoff of 25% in both races. Use of this cutoff could have avoided unnecessary biopsies in 20% of white and 17% of black subjects (P = 0.69). In receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for %fPSA was significantly higher than for total PSA in both blacks (0.76 versus 0.56, P <0.01) and whites (0.70 versus 0.54, P <0.001). In both races, higher %fPSA values indicated a lower risk of cancer and also predicted favorable pathologic features in radical prostatectomy specimens.Conclusions. A 25% fPSA cutoff detected 95% of cancers and reduced unnecessary biopsies in both races. Higher %fPSA values were associated with favorable postoperative histopathologic findings in both races. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)372-376
Number of pages5
Issue number3
StatePublished - Mar 2000

ASJC Scopus subject areas

  • Urology


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