PSA with Reflex to Free PSA
CPT Code(s):
84153
Turnaround Time:
8 hours
Specimen Requirements
Preferred Specimen:
Serum
Minimum Volume:
1.0 mL
Transport Container:
Serum Separator Tube (SST) or Red Top Tube
Transport Temperature:
Room Temperature
Collection Instructions:
Allow blood to clot completely prior to centrifugation. Separate serum from cells within 45 minutes of collection.
Rejection Criteria:
Citrate, Fluoride,Sodium Heparin, or EDTA plasma specimen; gross hemolysis; lipemia; improper labeling
Stability Criteria
Room Temperature:
24 hours
Refrigerated:
5 days
Frozen:
30 days
Clinical Significance
PSA with Reflex to Free PSA is a clinically significant diagnostic tool used to assess the risk of prostate cancer in patients with elevated levels of Prostate-Specific Antigen (PSA). This test provides additional information by measuring the percentage of free PSA in the blood, which can help differentiate between benign conditions and prostate cancer.
The specific clinical significance and diagnostic use of PSA with Reflex to Free PSA include:
1. Prostate Cancer Risk Assessment: PSA with Reflex to Free PSA is particularly useful in patients with moderately elevated total PSA levels (between 4 ng/mL and 10 ng/mL). By measuring the ratio of free PSA to total PSA, it helps differentiate between benign prostatic conditions (such as benign prostatic hyperplasia) and prostate cancer. A higher percentage of free PSA is associated with a lower risk of prostate cancer, while a lower percentage may indicate a higher likelihood of cancer.
2. Guiding Biopsy Decisions: In cases where total PSA levels are elevated and the free PSA percentage is low, the risk of prostate cancer is higher. This information helps guide decisions regarding the need for a prostate biopsy. A low free PSA percentage suggests a higher probability of cancer, prompting further investigation to confirm or rule out the presence of cancer.
3. Improving Diagnostic Accuracy: PSA with Reflex to Free PSA helps improve the diagnostic accuracy of PSAing. It reduces unnecessary biopsies by providing additional information to differentiate between benign and malignant conditions. By incorporating the free PSA measurement, clinicians can make more informed decisions about the need for further testing or interventions.
4. Risk Stratification: The test assists in stratifying the risk of prostate cancer in patients with elevated total PSA levels. The combination of total PSA and free PSA percentage helps categorize patients into different risk groups, such as low, intermediate, or high risk. This information aids in treatment planning, surveillance strategies, and determining the need for further diagnostic tests.
5. Monitoring Disease Progression: In patients diagnosed with prostate cancer, PSA with Reflex to Free PSA can be used for monitoring disease progression and treatment response. Serial measurements of total PSA and free PSA percentage over time provide valuable information about disease activity, treatment efficacy, and the need for additional interventions.
It is important to note that PSA with Reflex to Free PSA is not a definitive diagnostic for prostate cancer. It serves as a supplementary tool to aid in risk assessment and decision-making. Further evaluation, including prostate biopsy and imaging studies, may be necessary to confirm or exclude the presence of prostate cancer.
In summary, PSA with Reflex to Free PSA enhances the clinical significance of PSAing by providing additional information to assess the risk of prostate cancer. It helps guide biopsy decisions, improves diagnostic accuracy, and aids in risk stratification and disease monitoring. By incorporating the free PSA measurement, clinicians can make more informed decisions regarding patient management and the need for further investigations.