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Free PSA/Total PSA ratio

Cancer
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Report in 4Hrs

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At Home

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No Fasting Required

Details

Prostate-Specific Antigen test screens for prostate cancer and monitors treatment response.

₹675₹1,760

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AI Insights

Free PSA/Total PSA Ratio - Comprehensive Medical Test Guide

  • Why is it done?
    • Measures the proportion of free (unbound) PSA relative to total PSA to help differentiate between benign prostatic hyperplasia (BPH) and prostate cancer
    • Improves specificity of PSA screening by reducing unnecessary biopsies in men with borderline PSA levels (4-10 ng/mL)
    • Ordered when total PSA is elevated but cancer risk remains uncertain
    • Performed as follow-up to initial PSA screening or to monitor men with known prostate conditions
    • Used in men aged 40-75 with risk factors for prostate cancer or those with family history of prostate cancer
  • Normal Range
    • Normal Range: Free PSA/Total PSA ratio ≥25% (or 0.25) is generally considered normal and suggests lower cancer risk
    • Borderline Range: 15-25% ratio indicates intermediate cancer risk; further evaluation recommended
    • Abnormal Range: Free PSA/Total PSA ratio <15% (or <0.15) suggests higher risk of prostate cancer; biopsy may be warranted
    • Units of Measurement: Expressed as percentage (%) or decimal ratio (0.00-1.00)
    • Interpretation Guide: Higher free PSA percentage indicates lower cancer probability; lower percentage suggests higher cancer risk
  • Interpretation
    • Ratio ≥25%: Suggests benign prostatic disease (BPH or prostatitis); cancer risk is low; continued monitoring with repeat PSA testing at 1-2 year intervals may be appropriate
    • Ratio 15-25%: Intermediate cancer risk category; clinical judgment required; may warrant repeat testing, PSA density calculation, or further diagnostic imaging (MRI) before considering biopsy
    • Ratio <15%: Increased probability of prostate cancer present; urologist referral strongly recommended for consideration of prostate biopsy and further evaluation
    • Factors Affecting Results: Recent ejaculation (can increase free PSA), prostate trauma, digital rectal exam (DRE) within 48 hours, urinary tract infection, PSA testing variability between laboratories, and prostate size variations
    • Clinical Significance: The ratio is superior to total PSA alone in cancer detection; approximately 25-35% sensitivity for detecting cancer at cutoff of 25%; helps avoid unnecessary biopsies in men with elevated PSA due to benign causes
  • Associated Organs
    • Primary Organ: Prostate gland (male reproductive system)
    • Associated Conditions - Normal Results: Benign Prostatic Hyperplasia (BPH), chronic prostatitis, prostate trauma, urinary tract infection
    • Associated Conditions - Abnormal Results: Prostate cancer (adenocarcinoma), high-grade prostatic intraepithelial neoplasia (PIN), prostate cancer metastasis
    • Diseases Diagnosed/Monitored: Prostate cancer (early detection), benign prostatic conditions (differentiation), prostate cancer recurrence (post-treatment monitoring)
    • Potential Complications from Abnormal Results: Need for prostate biopsy (with risks of infection, bleeding, urinary retention), cancer progression if untreated, metastatic disease to bones and other organs, urinary obstruction, erectile dysfunction
  • Follow-up Tests
    • If Ratio ≥25% (Low Risk): Repeat PSA testing in 1-2 years; repeat free PSA/total PSA ratio if PSA rises; digital rectal examination (DRE) annually
    • If Ratio 15-25% (Intermediate Risk): PSA density calculation, repeat free PSA ratio in 3-6 months, PSA velocity assessment, consider multiparametric MRI (mpMRI) of prostate, possible urologist referral
    • If Ratio <15% (High Risk): Urgent urologist referral, multiparametric MRI (mpMRI) of prostate, transrectal ultrasound (TRUS)-guided prostate biopsy, consider biomarker testing (4Kscore, PHI, SelectMDx)
    • Complementary Tests: PSA velocity (change over time), PSA density (PSA level relative to prostate size), PSA isoforms, percent free PSA, molecular biomarkers (PHI - Prostate Health Index, 4Kscore), MRI-fusion biopsy
    • Monitoring Frequency for Known Conditions: Post-prostate cancer treatment: PSA every 3-6 months initially, then every 6-12 months based on treatment type; For BPH: yearly PSA and free PSA ratio if baseline was concerning; High-risk men: annual screening
  • Fasting Required?
    • Fasting Requirement: No - Fasting is NOT required for free PSA/total PSA ratio testing
    • Special Instructions: Avoid ejaculation for 48 hours before testing (can elevate PSA levels); Avoid DRE (digital rectal exam) or prostate massage for 48 hours before testing; Avoid vigorous exercise or cycling for 48 hours (can increase PSA); Do NOT perform transrectal ultrasound within 1 week before testing
    • Medications - No Restrictions: Most medications do not need to be discontinued; However, finasteride (Proscar, Propecia) and dutasteride (Avodart) decrease PSA levels by approximately 25-50%, so baseline PSA should be established before starting these medications
    • Patient Preparation: Schedule testing 48 hours or more after any urological procedures; Wear comfortable clothing for easy blood draw access; Inform healthcare provider of any recent prostate procedures or infections; Can eat and drink normally before the test
    • Specimen Collection: Standard venipuncture (blood draw) is performed; Typically 1-2 mL of blood is collected in a serum separator tube; Sample should be processed within 2 hours of collection for optimal results

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