Reference reagents for prostate-specific antigen (PSA): establishment of the first international standards for free PSA and PSA (90:10)

BACKGROUND Prostate-specific antigen (PSA) measurements in serum by immunoassay are widely used in the screening, diagnosis, and monitoring of patients with prostate cancer although the lack of common reference reagents has led in the past to wide differences in estimates. We report here the results of a WHO international collaborative study in which two preparations of PSA representative of the main immunoreactive components in serum, free PSA and PSA 90:10, and a preparation of recombinant DNA-derived PSA were assessed as potential standards for the calibration of diagnostic immunoassays for PSA. METHODS Coded vials of the candidate materials and serum preparations containing PSA in the clinically important range were provided to the 10 laboratories in the study, and participants were asked to perform PSA assays currently in use in their laboratories. Data from 89 immunoassays by 26 different method-laboratory combinations were contributed to the study and analyzed centrally at the National Institute for Biological Standards and Control. RESULTS Potency estimates of the preparations relative to the in-house calibrators were in good agreement with the target value of 1 microg of total PSA/vial, the preparation of free PSA giving 1.10 microg/vial (95% confidence interval, 0.99-1.21 microg/vial) and PSA 90:10, 1.11 microg/vial (95% confidence interval, 1.04-1.18 microg/vial). No immunoreactivity was detected in ampoules containing the recombinant material. Use of a common standard of PSA 90:10 significantly reduced the between-laboratory geometric coefficients of variation for serum samples included in the study and gave a much narrower range of potency estimates. CONCLUSIONS The preparation of free PSA was established by WHO as the First International Standard for PSA (free) with an assigned content of 1 microg of total PSA per vial. In addition, the preparation of bound PSA was established as the First International Standard for PSA (90:10) with an assigned content of 1 microg of total PSA per vial.