A low ratio of free PSA to total PSA requires clarification of the specific ratio and the specific value of total PSA to make a determination. If the total PSA is between 4-10ng/L and the ratio of free PSA level to total PSA is <0.16, a possible prostate malignancy is considered and a review or prostate puncture biopsy is recommended. If the ratio of free PSA to total PSA is >0.16, no malignant tumor of the prostate is considered and regular follow-up can be performed, but if the total PSA level is >10ng/L or more, regardless of the ratio of free PSA to total PSA, a review or prostate puncture biopsy is required, as there may be a malignant tumor of the prostate, so it is necessary to make a judgment based on the specific value. The actual PSA ratio is a lot more than a couple of times, and it’s a good idea to have an MRI of the prostate gland to further assist in the determination.