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A total of 4955 men were enrolled into the study. Serum tPSA, fPSA, and f\/t PSA ratios\u2009were determined for the study population. All males who had suspicious digital rectal examination and tPSA\u2009&gt;\u20094\u2009ng\/mL underwent transrectal ultrasonography\u2010guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by plotting the sensitivity versus 1\u2010specificity for the f\/t PSA ratio. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were obtained using various\u2009f\/t PSA ratio cutoffs for different age groups. There were 657 patients with a PSA level of 4\u201310\u2009ng\/mL. According to sensitivity and specificity f\/t% PSA cutoff points were determined to be 10%, 15%, 15%, and 10% in 50\u201359 years, 60\u201369 years, &gt;70 years, and all ages categories, respectively, in patients with initial PSA level of 4\u201310\u2009ng\/mL. f\/t PSA ratio had an area under the curve (AUC) value of 0.81 (95% confidence level: 0.80\u20130.82) for all age groups in detecting prostate cancer. f\/t PSA ratio has an AUC value of 0.669 (0.632\u20130.705) in detecting prostate cancer among patients with a PSA level of 4\u201310\u2009ng\/mL. Ten percent of f\/t PSA ratio had the highest specificity with PLR and 30% f\/t PSA ratio had the highest sensitivity with lower NLR in the all\u2010age categories. The current study shows that the use of f\/t PSA ratio in patients with PSA levels of 4\u201310\u2009ng\/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. The age\u2010related changes warrant further investigation in a large, multicentric, and multinational population to improve the clinical use of f\/t PSA cutoffs.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.kjms.2014.03.008","type":"journal-article","created":{"date-parts":[[2014,4,20]],"date-time":"2014-04-20T01:00:25Z","timestamp":1397955625000},"page":"545-550","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":24,"title":["The cutoff level of free\/total prostate specific antigen (f\/t PSA) ratios in the diagnosis of prostate cancer: A validation study on a Turkish patient population in different age categories"],"prefix":"10.1002","volume":"30","author":[{"given":"Bulent","family":"Erol","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat 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