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PSA (Prostate Specific Antigen) is found in serum in both free and bound forms, the latter complexed to alpha 1 anti-chymotrypsin (ACT) and to alpha 2 macroglobulin. The PSA-ACT complex is the main form assayed in serum.

Different techniques (immunocytochemistry, western blot, serum chromatography) have enabled the variation of the ratio of free PSA to total PSA depending on the pathology observed to be brought out. This ratio is higher in cases of benign hypertrophia than in those of prostate cancer. The phenomenon may be linked to a proliferation of ACT-secreting cells in prostate cancer.

For men with a level of total PSA (PSA + PSA-ACT) between 4 - 10 ng/ml, the combination of an assay specifically measuring free PSA with one measuring total PSA (calculation of the percentage of free PSA over total PSA) is a valuable tool in the differential diagnosis of prostate cancer.

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