Age-specific PSA reference values are recommended by the Department of Health and NICE as a referral trigger for men with abnormal PSA values. They are arbitrary values in the UK and are based on the international literature.
Patients and methods:
Data of 1970 men with benign histology from the Gwent screening study were used out of a cohort of 2063 men. The adaptive trimmed maximum likelihood method as the best way of removing outliers which do not come from a log-normal distribution was used after data transformation. The 95% percentile was used as cut-off value.
Results:
The true statistical 95% percentile for PSA in a screening population for the age groups 50–59.9 years, 60–69.9 years and 70–79.9 years are 3.2ng/ml, 5.6ng/ml and 8.1 ng/ml, respectively.
Conclusions:
These values differ from the recommended referral cut-off values by the Department of Health. The adoption of higher values for the older age groups may be a sensible policy to avoid unnecessary investigation in elder men with high PSA values due to benign disease.
MeliaJMossSJohnsL. Rates of prostate-specific antigen testing in general practice in England and Wales in asymptomatic and symptomatic patients: a cross-sectional study. BJU Int2004; 94 (1): 51–6.
MorganTOJacobsenSJMcCarthyWFJacobsonDJMcLeodDGMoulJW. Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med1996; 335 (5): 304–10.
8.
OesterlingJEKumamotoYTsukamotoTGirmanCJGuessHAMasumoriNSerum prostate-specific antigen in a community-based population of healthy Japanese men: lower values than for similarly aged white men. Br J Urol1995; 75 (3): 347–53.
9.
GreenJSHoldenSTBosePGeorgeDPBowsherWG. An investigation into the relationship between prostate size, peak urinary flow rate and male erectile dysfunction. Int J Impot Res2001; 13 (6): 322–5.
10.
MarazziAYohaiVJ. Adaptively truncated maximum likelihood regression with asymmetric errors. J Stat Plan Infer2004; 122 (1–2): 271–91.
11.
RoehrbornCGBoylePGouldALWaldstreicherJ. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology1999; 53 (3): 581–9.
12.
RaaijmakersRKirkelsWJRoobolMJWildhagenMFSchrderFH. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology2002; 60 (5): 826–30.
13.
OesterlingJEJacobsenSJCoonerWH. The use of age-specific reference ranges for serum prostate specific antigen in men 60 years old or older. J Urol1995; 153 (4): 1160–3.
14.
ParkerCMustonDMeliaJMossSDearnaleyD. A model of the natural history of screen-detected prostate cancer, and the effect of radical treatment on overall survival. Br J Cancer2006; 94 (10): 1361–8.
15.
BorerJGShermanJSolomonMCPlawkerMWMacchiaRJ. Age specific prostate specific antigen reference ranges: population specific. J Urol1998; 159 (2): 444–8.
16.
BasslerTJJrOrozcoRBasslerICO'DowdGJStameyTA. Most prostate cancers missed by raising the upper limit of normal prostate-specific antigen for men in their sixties are clinically significant. Urology1998; 52 (6): 1064–9.
17.
CatalonaWJRichieJPAhmannFRHudsonMAScardinoPTFlaniganRCComparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol1994; 151 (5): 1283–90.
18.
OesterlingJEJacobsenSJChuteCGGuessHAGirmanCJPanserLASerum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. Jama1993; 270 (7): 860–4.
19.
LofmanOLindahlTVarenhorstE. Age-specific reference values for serum prostate-specific antigen in a community-based population of healthy Swedish men. Scand J Clin Lab Invest1997; 57 (3): 225–32.
20.
KalishLAMcKinlayJB. Serum prostate-specific antigen levels (PSA) in men without clinical evidence of prostate cancer: age-specific reference ranges for total PSA, free PSA, and percent free PSA. Urology1999; 54 (6): 1022–7.
