Neoplasia: PSA in prostate cancer: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: PSA in prostate cancer

Sample item

A 66-year-old man has a total PSA of 7.5 ng/mL and a normal digital rectal examination. The free-to-total PSA ratio is 8%. How should this be interpreted?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. A low ratio raises the likelihood of prostate cancer, so a biopsy should be considered

PSA is organ-specific but not cancer-specific, and it is raised in benign hyperplasia, prostatitis and after instrumentation. In cancer, more PSA is bound to alpha-1-antichymotrypsin, so the free fraction is low. A free-to-total ratio below about 10% in the 4 to 10 ng/mL range raises concern, whereas a high ratio favours benign disease.

Option by option

  • A. A low ratio raises the likelihood of prostate cancer, so a biopsy should be considered (correct)

    A low free fraction indicates more complexed PSA, as seen in cancer, and supports biopsy.

  • B. A low ratio favours benign prostatic hyperplasia, so no further work-up is needed

    Benign hyperplasia is associated with a higher free fraction, so a low ratio does not reassure.

  • C. The ratio is irrelevant because PSA is specific for cancer at this level

    PSA is not cancer-specific, and the ratio helps to refine risk in the borderline range.

  • D. A ratio above 25% would favour cancer, so this result excludes it

    The relationship is the reverse: a high free fraction favours benign disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, A low ratio raises the likelihood of prostate cancer, so a biopsy should be considered. PSA is organ-specific but not cancer-specific, and it is raised in benign hyperplasia, prostatitis and after instrumentation.

Why is "A low ratio favours benign prostatic hyperplasia, so no further work-…" not the answer?

Benign hyperplasia is associated with a higher free fraction, so a low ratio does not reassure.

Why is "The ratio is irrelevant because PSA is specific for cancer at this le…" not the answer?

PSA is not cancer-specific, and the ratio helps to refine risk in the borderline range.

Why is "A ratio above 25% would favour cancer, so this result excludes it" not the answer?

The relationship is the reverse: a high free fraction favours benign disease.

What concept does this question test?

It tests Neoplasia: PSA in prostate cancer in Pathology. In cancer, more PSA is bound to alpha-1-antichymotrypsin, so the free fraction is low. A free-to-total ratio below about 10% in the 4 to 10 ng/mL range raises concern, whereas a high ratio favours benign disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: PSA in prostate cancer?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.