Are age-specific reference ranges for prostate specific antigen populationspecific?

Introduction: At present PSA is considered to be the lending screening test for prostate cancer. We determined whether in men 60 to 79 year old with a serum prostate specific antigen (PSA) within age specific PSA reference ra nges prostate biopsy could be safely eliminated. Methods: We retrospectivel y analysed all 60-79 year old men who had undergone radical perineal prosta tectomy (RPP) for prostate cancel (CaP) at our institution. All patients ha d undergone prostate biopsy following an abnormal rectal examination and/or PSA greater than 4.0 ng/ml. We compared out results using the standard ref erence range of 0 to 4.0 ng/ml with those we had obtained using the age spe cific PSA reference ranges of Oesterling et al. Results: 204 men between 60 -69 years and 67 men between 70-76 yeats had undergone RPP for CaP. Applyin g age specific PSA reference ranges 56 CaP would have been overlooked. Of t hose 46% had a favourable histology. Taken together 54% of the cancers over looked had an unfavourable histology. Conclusion: In contrast to previous r eports of unfavourable histological characteristics in only 5-24% of missed cancers, applying age specific PSA reference ranges, 54% of missed cancels in our patients exhibited an unfavourable histology. We therefore conclude that age specific PSA reference ranges did not safely eliminate the need f or prostate biopsy in our study population.