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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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The measurement of complexed prostate-specific antigen has a better performance than total prostate-specific antigen

Wolfgang Herrmann1 / Michael Stöckle2 / Marga Sand-Hill3 / Ulrich Hübner4 / Markus Herrmann5 / Rima Obeid6 / Bernd Wullich7 / Tillmann Loch8 / Jürgen Geisel9










Corresponding author: Prof. Dr. Wolfgang Herrmann, Department of Clinical Chemistry/Central Laboratory, University Hospital of Saarland, 66421 Homburg/Saar, Germany. Phone: +49-6841-1623070, Fax: +49-6841-1623109, E-mail:

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 42, Issue 9, Pages 1051–1057, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2004.211, June 2005

Publication History

January 22, 2004
July 12, 2004
Published Online:


The aim of this study was to compare the diagnostic utility of complexed prostate-specific antigen (cPSA) with total PSA (tPSA) in screening for prostate cancer. Serum concentrations of tPSA and cPSA were measured in 4479 adult men during the prostate cancer screening program in the Saarland region (Germany). The percentage of men with c/tPSA ratio above the cut-off value of 0.75 increased with increasing tPSA intervals: tPSA 0–0.9 µg/l, 4.4%; 1.0–1.9 µg/l, 24.3%; 2.0–2.9 µg/l, 43.9%; 3.0–3.9 µg/l, 50.4%; and 4.0–20 µg/l, 60.2%. The commonly accepted tPSA cut-off value of 3.9 µg/l matched to the 93rd percentile of the overall population (corresponding cPSA value, 2.9 µg/l). A total of 202 men out of 313 with increased cPSA had increased c/tPSA ratio (cut-off ≥ 0.75) vs. 186 out of 312 men with increased tPSA. Thus, an additional 16 men at high risk for prostate cancer were selected only if cPSA was utilised as a first line parameter. Our data show that, compared to tPSA, cPSA measurement will always detect more high-risk patients, independent of the cut-off levels utilised for cPSA, tPSA and c/tPSA ratio. cPSA is more effective than tPSA in selecting subjects with an elevated c/tPSA ratio who are at high risk of prostate cancer. Thus, cPSA might be seen as the superior first-line parameter in screening for prostate cancer. Using lower cut-off values for tPSA or cPSA than the commonly accepted values seems reasonable for screening purposes.

Keywords: cancer of the prostate; complexed/free prostate-specific antigen ratio; complexed prostate-specific antigen; free prostate-specific antigen; prostate-specific antigen; screening

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