PSA-ACT useful to reduce # of biopsies?

[kikoquilla]

I read an article study of Japanese men with PSA between 2 and 4 which concluded "PSA-ACT is better than total PSA and equivalent to the free-to-total ratio for detecting prostate cancer in men with PSA levels of 2.0-4.0 ng/ml, and is thus useful for reducing the number of unnecessary biopsies"

to Google "Prostate-specific antigen (PSA) complexed to alpha..."

I fall within the category my PSA is 2.54 at the moment last monday.  4 years ago it was 1.5.  I am 57 but they found this nodule.  I feel that I will go for a biopsy for no good reason.   What would be the best result of PSA-ACT test in numbers to indicate low chance of cancer like 10% only.

[kikoquilla]

Is it possible that if I go for PSA-ACT density testing will it come back indicating low chance of cancer?

At 2.54 PSA now my chance is like 24%

By the way thanks very much for your answer.

[HeinrikMD]

Hi,

I think you are referring to the study by Kobayashi et al.

You'll have to realize though what the figures really men. The study demonstrated that using the PSA-ACT to decide who should get a biopsy, among men with a high value (which was defined as a value of > or = to 1.5 - meaning if all men with this value and up the question becomes how many get unnecessary biopsies). If the decision to undergo biopsy would be based on this cut-off, the unnecessary biopsies would be about 32%. If the decision was based on the total PSA (defined as > or = to 2), the unnecessary biopsies would be about 40%.

It would be of course interesting to really answer your question, which I am paraphrasing as: what level of PSA-ACT corresponds to Prostate cancer risk of 10%?
Unfortunately, I don't have Kobayashi's entire text. If we use the experience of PSA, at a PSA less than 1 there is still about a 10% chance that cancer is present, hence I'm estimating that for PSA-ACT it may be about 0.7 -0.8.