What is free/total PSA ratio?

Although prostate cancer cells do not produce more PSA than benign prostate tissue, the
PSA produced from cancerous cells appears to escape an enzymatic processing that
cleaves the bond between PSA and its binding protein. Therefore, men with prostate
cancer have a greater fraction of complexed, or bound, serum PSA and a lower
percentage of total PSA that is free compared with men without prostate cancer.
Therefore, the free/total PSA ratio can be used in clinical practice to discriminate between
PSA elevation secondary to benign prostatic disease and prostate cancers. This is
particularly useful for patients with a total PSA level between 4.0 and 10.0 ng/mL and a
negative normal rectal exam to help the doctor to decide if a biopsy is necessary. In one
study, prostate cancer was found in 56% of men with a free/total PSA less than 0.10 but
in only 8% of men with free/total PSA greater than 0.25. Nevertheless, the concept of free
PSA must be used with caution as several factors may influence the free/total PSA ratio
such as temperature and prostate size. Furthermore, the free PSA measurement is not
clinically useful for patients with total serum PSA values less than 10.0 ng/mL or in the
follow-up of patients with known prostate cance
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