Activity does not affect free and total prostate-specific antigen levels but lowers the free-to-total prostate-specific antigen ratio

Prostate-specific antigen (PSA) and the ratio of free-to-total PSA are widely used tumour markers, but the effect of exercise on these parameters is unclear. We aimed to determine whether long-term physical training was associated with changes in serum PSA by comparing PSA concentrations in middle-aged master athletes (n = 12), recreational athletes (n = 12) and sedentary controls (n = 12). Serum total PSA and free PSA concentrations were assessed using an electrochemiluminescence immunoassay; there were no significant differences among the groups. The free-to-total PSA ratio was significantly lower statistically in master athletes compared with recreational athletes, but this is not clinically significant as both values (0.22 versus 0.31, respectively) were within the normal range. These results indicate that the free-to-total PSA ratio may be affected by long-term athletic training, and could be important when evaluating athletes with prostate-related disorders.