Elsevier

Urology

Volume 76, Issue 5, November 2010, Pages 1042-1046
Urology

Risk Assessment and Diagnosis
Association Between Glomerular Filtration Rate, Free, Total, and Percent Free Prostate-specific Antigen

https://doi.org/10.1016/j.urology.2009.05.100Get rights and content

Objectives

To determine the relationship between glomerular filtration rate (GFR) and free prostate-specific antigen (fPSA), percent-free PSA (%fPSA), and total PSA (tPSA) in patients with diminished kidney function not on dialysis, using nationally representative data.

Methods

A total of 3782 men aged ≥ 40 years who participated in the National Health and Nutrition Examination Survey 2001-2006, and who met eligibility criteria for PSA testing were included in the final study population. GFR (mL/min/1.73 m2) was calculated using the Modification of Diet in Renal Disease equation 7 and categorized as ≥ 90, 60 to < 90, and 15 to < 60. Distribution of tPSA, fPSA, and %fPSA were estimated by GFR category and by age and race. Multivariate linear regression models were fit to determine the adjusted relationship between GFR and tPSA and %fPSA after adjusting for age, race, and body mass index.

Results

The multivariate linear regression analysis showed that GFR had a linear relationship with tPSA that was of borderline significance. There was a significant nonlinear relationship between GFR and %fPSA (P <.001): increased GFR was associated with a decrease in %fPSA for GFR levels below 90 [eg, change in %fPSA = −2.67 (95% CI −3.56, −1.77) for a GFR of 85 as compared with 65; P <.001]. The decline in %fPSA with increasing GFR was nonsignificant for GFR levels above 90.

Conclusions

Our finding that renal function as measured by GFR is negatively associated with %fPSA has potential implications for use of this test in men with renal disease.

Section snippets

Study Population

NHANES is a nationally representative cross-sectional survey of the adult U.S. noninstitutionalized population. A detailed description of sampling and data collection procedures has been described elsewhere.8 People with low income, adults aged 60 years or older, African-Americans, and Mexican-Americans were oversampled. Overall response rates for the 2001-2002, 2003-2004, and 2005-2006 surveys were 84%, 79%, and 80% for the interview component, and 80%, 76%, and 77% for the examination

Results

The distribution of fPSA, tPSA, and %fPSA by GFR category is presented in Table 1. The median fPSA and tPSA increased with successively lower categories of renal function. The percentage of those with %fPSA < 25 decreased with a successive decline in renal function.

Among men with a GFR ≥ 90, the median fPSA was significantly higher among those aged 70-79 years than among those aged < 70 years, and the median tPSA was significantly higher among those aged 50-59 years than among those aged 40-49

Comment

Using nationally representative data, we have confirmed the finding that renal function as measured by GFR is negatively associated with %fPSA. Although tPSA declined somewhat with increasing GFR, this trend was of borderline significance.

One previous study examined the relationship between fPSA, %fPSA, and GFR (measured by the gold standard iohexol clearance method). The study found that median fPSA and %fPSA levels were significantly higher among men with a GFR < 90 and that there was a

Conclusions

Studies have consistently shown that fPSA and %fPSA are elevated in men with end-stage renal disease or on dialysis. This cross-sectional study found that in patients with moderately impaired kidney function, the moderately decreased GFR resulted in a significantly increased %fPSA, thus, significantly expanding the population for which this finding may be important. Additional studies are needed to determine what effect this finding may have on prostate cancer detection in men with GFR between

References (29)

  • W.J. Catalona et al.

    Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial

    JAMA

    (1998)
  • L. Bruun et al.

    Increase in percent free prostate-specific antigen in men with chronic kidney disease

    Nephrol Dial Transplant

    (2009)
  • K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification

    Am J Kidney Dis

    (2002)
  • M. Saraiya et al.

    Total and percent free prostate-specific antigen levels among U.S. men, 2001-2002

    Cancer Epidemiol Biomarkers Prev

    (2005)
  • Cited by (21)

    • Prostate health index and prostate cancer gene 3 score but not percent-free Prostate Specific Antigen have a predictive role in differentiating histological prostatitis from PCa and other nonneoplastic lesions (BPH and HG-PIN) at repeat biopsy

      2015, Urologic Oncology: Seminars and Original Investigations
      Citation Excerpt :

      Atypical small acinar proliferation cases were excluded, as they very often show false-negative results at first biopsy. Patients with marked blood protein alterations, having hemophilia, or with moderately impaired kidney function were excluded from the study because such conditions may alter p2PSA concentration, which is necessary to calculate the PHI [16]. Patients then underwent transrectal ultrasound-guided re-Bx, according to a standardized extended scheme: at least 18 peripheral and transition zone cores were performed by experienced urologists.

    • The investigation of total PSA, free PSA, and free/total PSA ratio in patients with liver cirrhosis patients according to child-pugh score

      2013, Urology
      Citation Excerpt :

      It is well known that the liver has an important role in the elimination of tPSA and fPSA. In addition, the kidneys have a significant role only in the destruction of fPSA by glomerular filtration due to its molecular size (40-50 kDa).10,26 In the present study, renal function tests were similar to those of the control group.

    • Prostate specific antigen levels and prostate cancer detection rates in patients with end stage renal disease

      2012, Journal of Urology
      Citation Excerpt :

      The 95th percentile reference ranges were derived from 2,119 healthy men between ages 40 and 79 years with no history of PCa or prostatectomy and determined by age in decades, as in our study. While renal dysfunction, hemodialysis and renal transplantation do not affect circulating total PSA, they increase free PSA.19–23 There is concern that using PSA to screen for PCa in the general population may potentially lead to the over diagnosis and subsequent overtreatment of clinically insignificant tumors.24

    • Association between smoking status, and free, total and percent free prostate specific antigen

      2012, Journal of Urology
      Citation Excerpt :

      The NHANES is a nationally representative cross-sectional survey of the adult United States noninstitutionalized population. A detailed description of sampling and data collection procedures has been published elsewhere.14 The overall response rates for the 2001 to 2002, 2003 to 2004 and 2005 to 2006 surveys were 84%, 79% and 80% for the interview component, and 80%, 76% and 77% for the examination component, respectively.

    View all citing articles on Scopus

    The findings in the article represent those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

    View full text