Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter March 3, 2022

Spurious results for total and free prostate-specific antigen (PSA); sometimes really “a riddle wrapped in a mystery inside an enigma”

Romolo Marco Dorizzi ORCID logo, Paolo Maltoni, Claudio Sgarzani, Monica Torello and Francesco Montanari

Corresponding author: Romolo Marco Dorizzi, Clinical Pathology Unit, Hub Laboratory, AUSL Romagna, Cesena, Italy, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Not applicable.


1. Ferraro, S, Biganzoli, EM. The clinical value of assessing the inter-method bias: the lesson from prostate specific antigen measurement. Clin Chem Lab Med 2022;60:149–51.10.1515/cclm-2021-1125Search in Google Scholar PubMed

2. AACC Artery. Free prostate specific antigen. Available from: [Accessed 8 Feb 2022].Search in Google Scholar

3. Huang, HQ, Zhang, Y, Xu, HG. Different free prostate-specific antigen to total prostate-specific antigen ratios using three detecting systems. J Clin Lab Anal 2018;32:e22231. in Google Scholar

4. Van Duijnhoven, HL, Péquériaux, NC, Van Zon, JP, Blankenstein, MA. Large discrepancy between prostate-specific antigen results from different assays during longitudinal follow-up of a prostate cancer patient. Clin Chem 1996;42:637–41. in Google Scholar

5. Park, S, Wians, FHJr, Cadeddu, JA. Spurious prostate-specific antigen (PSA) recurrence after radical prostatectomy: interference by human antimouse heterophile antibodies. Int J Urol 2007;14:251–3. in Google Scholar

6. Pedrosa, W, Teixeira, L. Interference of heterophilic antibodies with free prostate-specific antigen in the Beckman-Coulter (Unicel DxI) assay, inverting the free/total prostate-specific antigen ratio. Ann Clin Biochem 2009;46:344–5. in Google Scholar

7. Cavalier, E. Aberrant results observed with four immuno-assays for total and free prostate-specific antigen (PSA) determination: a case-report. Clin Chem Lab Med 2011;50:583–4. in Google Scholar

8. Jung, K, Stephan, C, Lein, M. Assay-dependent abnormalities in measurements of prostate-specific antigen in serum: an occasional occurrence, but of clinical significance. Clin Chem Lab Med 2012;50:585–6. in Google Scholar

9. Lautenbach, N, Müntener, M, Zanoni, P, Saleh, L, Saba, K, Umbehr, M, et al.. Prevalence and causes of abnormal PSA recovery. Clin Chem Lab Med 2018;56:341–9. in Google Scholar

10. Ferraro, S, Bussetti, M, Rizzardi, S, Braga, F, Panteghini, M. Verification of harmonization of serum total and free prostate-specific antigen (PSA) measurements and implications for medical decisions. Clin Chem 2021;67:543–53. in Google Scholar

11. Ferraro, S, Bussetti, M, Bassani, N, Rossi, RS, Incarbone, GP, Bianchi, F, et al.. Definition of outcome-based prostate-specific antigen (PSA) thresholds for advanced prostate cancer risk prediction. Cancers 2021;13:3381–95. in Google Scholar

12. Kavsak, PA, Hotte, SJ. A large number of fresh samples and a wide range of total prostate-specific antigen (tPSA) concentrations is important to detect differences in PSA methods. Clin Chem 2021;67:1155–7. in Google Scholar

Received: 2022-01-13
Accepted: 2022-02-22
Published Online: 2022-03-03
Published in Print: 2022-04-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston