Free PSA
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This ratio helps distinguish between benign prostate conditions like Benign Prostatic Hyperplasia (BPH) and prostate cancer, especially when total PSA is in the intermediate range (4–10 ng/mL)
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🧪 What is Free PSA?
Free PSA refers to the unbound form of Prostate-Specific Antigen (PSA) circulating freely in the blood. PSA is a protein produced by the prostate gland, and exists in two main forms in the bloodstream:
- Free PSA – Not bound to blood proteins
- Bound PSA – Attached to proteins like alpha-1-antichymotrypsin
The total PSA test measures both, while the free PSA test specifically measures the unbound fraction.
The % free PSA (free PSA / total PSA × 100) helps differentiate between benign prostate conditions and prostate cancer, especially when total PSA is moderately elevated (4–10 ng/mL).
❓ Why is the Free PSA Test Done?
To:
- Refine prostate cancer risk when total PSA is borderline (4–10 ng/mL)
- Differentiate between:
- Benign Prostatic Hyperplasia (BPH)
- Prostatitis
- Prostate cancer
- Decide whether prostate biopsy is necessary
- Monitor patients with elevated PSA levels
📊 Normal Ranges
Parameter | Normal Range |
|---|---|
Free PSA | Lab-dependent; reported as a value or % of total PSA |
% Free PSA (Free PSA / Total PSA × 100) |
- >25% → Low risk of prostate cancer
- 10–25% → Intermediate risk
- <10% → High risk of prostate cancer
🔍 Percent free PSA is most clinically meaningful when total PSA is between 4 and 10 ng/mL.
📈 Interpretation of Free PSA Results
% Free PSA | Risk Interpretation |
|---|---|
>25% | Suggests benign cause (e.g., BPH) |
10–25% | Gray zone – biopsy decision based on age, family history, DRE, etc. |
<10% | Suggests higher risk of prostate cancer |
PSA levels can be influenced by age, prostate size, infection, recent ejaculation, and procedures like DRE or catheterization.
🧠 Associated Organs and Conditions
Organ | Relevance |
|---|---|
Prostate Gland | Primary source of PSA production |
Urinary Tract | Inflammation or instrumentation can elevate PSA |
Liver/Kidneys | Clear PSA from circulation (less clinically relevant) |
❌ Causes of Elevated Total PSA with Normal Free PSA Ratio
- Benign Prostatic Hyperplasia (BPH)
- Prostatitis
- Urinary tract infection
- Recent ejaculation
- Prostate manipulation (e.g., DRE, catheter)
🔄 Related / Follow-Up Tests
- Total PSA
- Digital Rectal Exam (DRE)
- PSA Density (PSA/prostate volume)
- PSA Velocity (change over time)
- Prostate MRI
- Prostate Biopsy – If high suspicion
- PCA3 / PHI (Prostate Health Index) – Additional prostate cancer markers
✅ Fasting Required?
Parameter | Requirement |
|---|---|
Fasting Required? | ❌ No fasting required for Free PSA testing |
⚠️ Avoid ejaculation or prostate manipulation (e.g., DRE, cycling) for 24–48 hours before the test to avoid falsely elevated PSA levels.
📝 Summary
Parameter | Summary |
|---|---|
What | Measures unbound PSA in the blood to assess prostate cancer risk |
Why Test | To differentiate between BPH and prostate cancer, especially when total PSA is 4–10 ng/mL |
Normal % Free PSA | >25% suggests benign cause; <10% suggests higher cancer risk |
High Free PSA | Suggests BPH or prostatitis |
Low Free PSA (<10%) | Suggests higher likelihood of prostate cancer |
Follow-up Tests | Total PSA, DRE, MRI, biopsy, PSA velocity, PHI |
Fasting Required | ❌ No, but avoid ejaculation or DRE 24–48 hours prior |
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