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Free Serum Prostate-Specific Antigen and Screening for Prostate Cancer-Reply

William J. Catalona, MD; Deborah S. Smith, PhD
JAMA. 1996;275(11):838. doi:10.1001/jama.1996.03530350019022.
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In Reply.  —We agree with Dr Bangma and colleagues that additional study is required to determine whether measurement of the percentage of free PSA is the best method for increasing the specificity of PSA screening for prostate cancer detection. Although our study is preliminary, it is encouraging that our results are consistent with reports of other investigators from around the world who have used different study methods and assays.1-3 In the study by Bangma et al,4 using still another assay in men with PSA levels of 4 to 10 ng/mL, a cutoff of 28% free PSA would have detected 91% of cancers and eliminated 19% of negative biopsies; in the subset with a gland volume less than 50 cm3, a cutoff of 19% would have detected 91% of the cancers and eliminated 49% of negative biopsies. The reason for the lower specificity in the study by Bangma


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