Age Specific Prostate Specific Antigen Reference Ranges: Population Specific

Age Specific Reference Ranges for Serum Prostate-Specific Antigen in Black Men

AGE SPECIFIC PROSTATE SPECIFIC ANTIGEN REFERENCE RANGES: POPULATION SPECIFIC

JOSEPH G. BORER, JOEL SHERMAN, MICHAEL C. SOLOMON, MARC W. PLAWKER AND RICHARD J. MACCHIA

From the Department of Urology, State University of New York Health Science Center, Brooklyn, New York

Purpose: We determined whether 60 to 79-year-old men with a negative digital rectal examination and a serum prostate specific antigen (PSA) within age specific PSA reference ranges could safely forgo prostate biopsy.

Materials and Methods: We reviewed the medical records of all 60 to 79-year-old men at the Brooklyn Veterans Administration Medical Center who had a PSA assay, digital rectal examination and subsequent prostate biopsy for an abnormal rectal examination and/or PSA greater than 4.0 ng./ml. from January 1991 through August 1995. We compared our results using the standard reference range of 0 to 4.0 ng./ml. with those obtained had we used any of 4 different age specific PSA reference ranges.

Results: We performed 1,280 prostate biopsies in 1,046 men with available PSA and digital rectal examination data. Using age specific PSA reference ranges 73 of 1,280 biopsies (5.7%) would have been avoided. Of those 73 avoided biopsies 15 (20.5%) had cancer that would have gone undetected and 9 of 15 (60%) undetected cancers had unfavorable histology. Results were not statistically significantly different among the 4 age specific PSA reference ranges. Regarding race, cancer detection rates were significantly higher for black compared with white men but there was no statistically significant difference for missed cancers or missed cancers with unfavorable histology.

Conclusions: In contrast to previous reports of unfavorable histological characteristics in only 5% of missed cancers using age specific PSA reference ranges, 60% of missed cancers in our patients exhibited unfavorable histology. We conclude that age specific PSA reference ranges did not safely eliminate the need for prostate biopsy in our study population. In 60 to 79-year-old men with a negative digital rectal examination we continue to use PSA greater than 4.0 ng./ml. as an indication for prostate biopsy.

Journal of Urology, 159(2) Feb 1998

Age Specific Reference Ranges for Serum Prostate-Specific Antigen in Black Men

Morgan TO, Jacobsen SJ, McCarthy WF, Jacobson DJ, McLeod DG and Moul JW.
The New England Journal of Medicine 1996, 335: 304-310.


This study determines distinct age specific reference ranges for serum PSA in black and white men, based upon an army population of over 4000 individuals. The mean PSA is found to be higher and the range of PSA wider in black men than white. Thus, if the 95th centile is chosen as the upper limit of normal, 40% of cases of prostate cancer may be missed in the black population. Utilising receiver-operator curves as their statistical tool, the ranges are redefined for white men as 0 - 2.5 ng/ml aged under 49, and 0 - 3.5 ng/ml aged over 50 years. For black men, the ranges are 0 - 2.0 ng/ml for age group 40-49, 0 - 4.0 ng/ml for 50 - 59, 0 - 4.5 for 60 - 69 and 0 - 5.5 for 70 - 79 years.