{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:27:41Z","timestamp":1784723261443,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyse whether the percentage of free to total prostate\u2010specific antigen (%fPSA) is a prognostic biomarker in metastatic castration\u2010resistant prostate cancer (mCRPC), as novel studies suggest an elevated %fPSA is associated with adverse oncological outcomes for men with biochemical recurrence of prostate cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A biobank prospectively collated at mCRPC diagnosis was analysed for %fPSA. Clinicopathological characteristics, systemic therapies and survival outcomes were recorded. Patients were stratified by a %fPSA cut\u2010off of 15%. Cox proportional hazard models evaluated whether %fPSA was associated with overall survival (OS) and cancer\u2010specific survival (CSS) across the cohort and by treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 254 patients analysed with newly diagnosed mCRPC: 161 (63%) men having a %fPSA \u226515%. The median follow\u2010up was 25.6\u2009months. The median cohort OS and CSS was 39.6 and 43.8\u2009months, respectively. Patients with a %fPSA \u226515% had lower median PSA level (31.30 vs 50.80\u2009ng\/mL;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007) and otherwise comparable clinicopathological and treatment profiles to men with a %fPSA &lt;15%. Adjusting for PSA and on multivariable analysis, a %fPSA \u226515% was associated with shorter OS (multivariable hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.02\u20132.40;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039). Among men treated with docetaxel, a %fPSA \u226515% was associated with worse OS (HR 1.84, 95% CI 1.03\u20133.26;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.038) and CSS. Conversely, %fPSA was not associated with outcomes for men receiving androgen receptor pathway inhibitors (abiraterone acetate or enzalutamide).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An elevated %fPSA appears to be an adverse prognostic biomarker. Findings are consistent with biochemical recurrence studies, suggesting a biological basis. Validation and mechanistic studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16751","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T03:40:05Z","timestamp":1745552405000},"page":"329-335","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Percentage of free to total\n                    <scp>PSA<\/scp>\n                    as a biomarker of survival in metastatic castration\u2010resistant prostate cancer"],"prefix":"10.1111","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4990-8445","authenticated-orcid":false,"given":"Andrew W.","family":"Silagy","sequence":"first","affiliation":[{"name":"Department of Urology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Surgery University of Melbourne, Austin Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dixon T.S.","family":"Woon","sequence":"additional","affiliation":[{"name":"Department of Urology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Surgery University of Melbourne, Austin Health  Melbourne Victoria Australia"},{"name":"Division of Urology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Kostos","sequence":"additional","affiliation":[{"name":"Medical Oncology Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Bernardino","sequence":"additional","affiliation":[{"name":"Division of Urology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5551-9817","authenticated-orcid":false,"given":"Ting W.","family":"Yiu","sequence":"additional","affiliation":[{"name":"Department of Urology Austin Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian S.","family":"Wettstein","sequence":"additional","affiliation":[{"name":"Division of Urology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5777-2138","authenticated-orcid":false,"given":"Hanan","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Division of Urology University of Toronto  Toronto Canada"},{"name":"Urology Department Upstate Medical University  Syracuse NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime O.","family":"Herrera\u2010C\u00e1ceres","sequence":"additional","affiliation":[{"name":"Division of Urology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hina","family":"Shiakh","sequence":"additional","affiliation":[{"name":"Division of Urology University of Toronto  Toronto 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