hi folks - in a nutshell, this article discusses the importance of the
free test when used with other factors.  the bottom line is if men are
aware of the free psa tests as well as the regular psa test, if they
were dx'ed with pca, it could make the difference between organ confined
or where it has spread.  the article is shown below.

~ curtis

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high-risk men should be screened with percent-free prostate-specific
antigen (PSA) testing even if total PSA and digital rectal examination
(DRE) are normal.  according to the results of a study published in
urology., rate of aggressive cancer was about 60% in this population
with low percent-free PSA.

between october 1996 and april 2002, 310 asymptomatic high-risk men with
no history of prostate cancer, benign prostatic hyperplasia or prostatic
intraepithelial neoplasia received screening in the Prostate /Cancer
Risk Assessment Program at Fox Chase.  of the 310 men, 174 (56%) were
African American and 202 (65%) had at least one first-degree relative
with prostate cancer.

men with a total PSA between 2 and 10 ng/mL also had testing of
percent-free PSA.  of the 310, 62 were referred for transrectal
ultrasound-guided prostate biopsy because of percent-free PSA less than
27%, abnormal DRE or total PSA greater than 4 ng/mL.

of 40 patients who had the recommended biopsy, 21 were diagnosed with
prostate cancer, yielding a cancer detection rate of 53% of all men
undergoing biopsy and an overall cancer detection rate of 6.8% in this
this high-risk population.

there were 37 high-risk men (median age, 54 years) with a total PSA
level between 2 and 4 ng/mL (median, 2.7 ng/mL) and a normal DRE in whom
percent-free PSA level was less than 27% (median, 16% range, 8% - 25%)
of these 37 men, 23 (62%) proceeded with the recommended prostate biopsy
and 12 were diagnosed with prostatic adenocarcinoma.  cancer detection
rate was 52% in men undergoing biopsy and 32% in all  men with a normal
DRE, a total PSA between 2 and 4 ng/mL and a percent -free PSA less than
27%.

"in this unique population at high risk for prostate cancer, a percent
free PSA of less than 27% was found to be useful for detecting
early-stage but clinically significant cancers in men with a total PSA
value between 2 and 4 ng/mL and normal DRE findings."  the authors
write, "although these men can be followed annually and biopsied when
their total PSA level rises about the upper limit of normal, an
opportunity may be lost and clinically relevant cancers may no longer be
organ-confined."

knowledge is power - growing old is mandatory - growing wise is optional