Free PSA index (ratio of free PSA/total PSA) is an important laboratory marker used in oncourology to assess the condition of prostate tissue with moderately elevated total PSA levels.

PSA circulates in the blood in two forms: tied (with whey proteins) and free (unbound). Total PSA is the sum of both forms. Studies have shown that in benign processes (adenoma, prostatitis) the proportion of free PSA is higher, and in malignant tumors most of the antigen binds to proteins, so the percentage of free PSA decreases.

What is this study for?

Differential diagnosis: To differentiate between prostate cancer and benign hyperplasia (adenoma) or prostatitis, especially when the total PSA level is in the so-called "gray zone" (from 4.0 to 10.0 ng/mL).
Optimization of biopsy indications: Allows you to avoid a traumatic and expensive prostate biopsy in cases where the probability of oncology is low.
Early detection of oncology: Increases the accuracy of primary diagnosis of prostate cancer.

Who is recommended to take the test?

Men with elevated total PSA levels (especially in the range of 4.0–10.0 ng/mL).
Men aged 45–50 years during an annual preventive examination by a urologist.
Men with a strong family history (if their father or brother has been diagnosed with prostate cancer).
If there are symptoms of urinary incontinence (weak stream, frequent urges, feeling of incomplete bladder emptying).

Preparation for the study

To avoid false positive results associated with mechanical irritation of the prostate, it is important to follow these rules:

On an empty stomach: Blood is donated in the morning, after 8–12 hours of fasting. Drinking clean water is allowed.
Abstinence from sexual contact: Avoid ejaculation 48 hours before blood collection.
Exclusion of medical manipulations: The analysis seems to or 10–14 days after a digital rectal examination, prostate massage, ultrasound (TRUSD), cystoscopy. At least 6–8 weeks should pass after a prostate biopsy.
Physical activity: Refrain from cycling, exercise bikes, and equestrian sports 2–3 days before the study.

Interpretation of results

The result is calculated using the formula: (Free PSA / Total PSA) × 100%.

Over 25%: Low risk of cancer. Most likely, an increase in total PSA is due to benign hyperplasia (adenoma) or inflammation (prostatitis).
15% – 25%: Moderate risk zone. Requires ongoing monitoring by a urologist.
Less than 15%: Increased risk of prostate cancer. Usually an indication for prostate biopsy or additional instrumental examinations (MRI).

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