Whilst some men with a PSA below the currently accepted “normal” age-specific threshold will have prostate cancer, it is also true that many men with a PSA above this threshold will not have prostate cancer as an elevated PSA can be attributable to a number of benign conditions as well apart from the presence of prostate cancer. Considerable efforts have been made to improve the sensitivity and specificity of PSA testing including the adoption of free-to-total PSA ratios, %free PSA, [-2]pro-PSA, PSA density and PSA velocity. The introduction of these parameters into prostate cancer prediction algorithms can only yield modest improvements in the diagnostic accuracy of PSA.
