Usefulness of free PSA ratio to enhance detection of clinically significant prostate cancer in patients with PI-RADS<3 and PSA≤10

Background: The necessity of prostate biopsy in patients with a Prostate Imaging-Reporting and Data System (PI-RADS) score below 3 and prostate-specific antigen (PSA) levels of 4-10 ng/ml remains controversial. We tested the diagnostic performance of the free PSA ratio (%fPSA) in detecting clinically significant cancer (CSC) in patients with PI-RADS 17.6%, compared to 32 out of 94 patients (34%) with %fPSA <17.6%. Conclusions: In patients with PI-RADS <3 and PSA ≤10 ng/ml, %fPSA values < 17.6% may facilitate early prostate cancer diagnosis in those who might not undergo biopsy based on MRI results alone. Additionally, unnecessary biopsies could be avoided in patients with elevated PSA levels when %fPSA exceeds 17.6%.