Age-Adjusted Reference Values for Prostate Specific Antigen - A Systematic Review and Meta-Analysis.

Area of Science:

• Urology
• Public Health
• Biostatistics

Background:

• Prostate-specific antigen (PSA) is a key biomarker in prostate cancer screening.
• Establishing accurate reference values for PSA is crucial for early detection and diagnosis.
• Existing reference values may not adequately account for demographic variations, particularly age and ethnicity.

Purpose of the Study:

• To systematically evaluate the evidence on ethnic differences in age-adjusted reference values of PSA.
• To synthesize current data on PSA reference ranges across different age groups and ethnicities.

Main Methods:

• A systematic review of English-language articles published from inception to December 2019 was conducted.
• Medline, Embase, and Cochrane databases were searched.
• Studies reporting the 95th percentile of PSA in healthy men aged 40-79 were included; methodological quality was assessed.

Main Results:

• Forty-three studies encompassing 325,514 participants were analyzed.
• PSA reference values showed a considerable heterogeneity, with age and ethnicity as significant contributors.
• Pooled upper PSA limits increased with age, ranging from 2.1 ng/ml (40s) to 6.5 ng/ml (70s).

Conclusions:

• Moderate quality evidence indicates that upper PSA reference limits increase with age.
• Significant ethnic differences in PSA reference values were identified.
• These findings underscore the importance of considering age and ethnicity in PSA interpretation.