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

Objectives. To investigate the relationship between age and total prostate- specific antigen (tPSA), free PSA (fPSA), and percent free PSA (%fPSA) in m en 48 to 79 years old without clinical evidence of prostate cancer. We dete rmined age-specific ranges for each parameter and compared the results with previously published studies in similar populations. Methods. Nine hundred eighty-three men (96% white) from the random-sample c ommunity-based Massachusetts Male Aging Study were analyzed. Men with PSA 4 .1 ng/mL or greater were referred for biopsy and those with positive biopsi es or with medical record, cancer registry, or self-reported evidence of pr ostate cancer were excluded. Results, The median tPSA increased 38.6% per decade (95% confidence interva l 28.7% to 49.3%). Because of the greater variability at older ages, the 95 th percentile increased faster than the median, leading to the following ag e-specific upper limits of normal: 2.84 for 50 to 59 years, 5.87 for 60 to 69 years, and 9.03 for 70 to 79 years. The pattern of association between f PSA and age was similar to tPSA. The 50th and 5th percentiles of %fPSA were 25.3% and 13.2%, respectively, regardless of age. Conclusions. Establishing age-specific screening cutoffs based on the age-s pecific upper limits of normal will ensure low false-positive biopsy rates but may also lead to low true positive rates (ie, low sensitivity) in older age groups. Both sensitivity and specificity should be considered when cou nseling patients. The independence of %fPSA with age confirms others' findi ngs. (C) 1999, Elsevier Science Inc.