NORMAL RANGE PROSTATE-SPECIFIC ANTIGEN VERSUS AGE-SPECIFIC PROSTATE-SPECIFIC ANTIGEN IN SCREENING PROSTATE ADENOCARCINOMA

Objectives Prostate-specific antigen (PSA) has become the most useful serum tumor marker in the diagnosis and screening of prostate adenocar cinoma. The currently cited reference range of normal (0 to 4.0 ng/mL monoclonal) lacks both the sensitivity and specificity to be universal ly accepted as a screening test, and alternatives to serum PSA have be en proposed, such as PSA density, PSA velocity, and age-adjusted PSA. Age-adjusted PSA takes into account the facts that as men grow older t he prostate enlarges and that screening should have maximum sensitivit y in younger men and maximum specificity in older men. Methods. A popu lation of 4710 men with no known history of prostate adenocarcinoma un derwent 5629 examinations by transrectal ultrasound of the prostate (T RUS) from 1987 to 1994. This population consists of Mobile Urology Gro up, Mobile, Alabama, and Emery University, Atlanta, Georgia, patient d atabases. We have examined our data to determine the sensitivity, spec ificity, and positive predictive values for normal range PSA (0 to 4 n g/mL) versus age-specific PSA values. Results. A total of 2040 patient s had an abnormal digital rectal examination (DRE) and 3581 procedures were performed for an elevated PSA and a normal DRE. Biopsies were pe rformed in 2657 patients with 945 (35.6%) positive for cancer. Criteri a for biopsy included elevated PSA (more than 4 ng/mL), PSA density mo re than 0.15, abnormal DRE, or suspicious TRUS, Patients were grouped according to decade: group 1 (ages 40 to 49 years, n = 183), group 2 ( ages 50 to 59 years, n = 1018), group 3 (ages 60 to 69 years, n = 2358 ), and group 4 (ages 70 to 79 years, n = 1687). Conclusions. Use of th e age-specific range for PSA increases the sensitivity in younger men more likely to benefit from treatment, and decreases the biopsy rate i n older patients who may not be candidates for aggressive treatment. A ge-adjusted PSA is the most valuable for patients over the age of 70 y ears of whom 22% would be spared TRUS with biopsy.