Over 48,000 baseline prostate-specific antigen measurements in young men: a 16-year time-analysis

To broaden our understanding of baseline PSA variations over the last decades in men under 40 years old.

We analysed the baseline total PSA of 48,896 men below the age of 40 years, grouped into 3 age groups: <30 (n = 6,123), 30-35 (n = 16,118), and >35 (n = 25,351) years old. Multiple linear regression model predicted the average LogPSA per month as a function of time, age, and testing rate during the 16-year period of the data (2003-2018).

The average age and standard deviation were 34.5 ±4.6 years, and the median PSA ± interquartile range was 0.63 ±0.46 ng/dl with a leftward skew towards zero (81% of results below 1 ng/dl) in all years. The average LogPSA was steadily rising over time, independent of age and testing rate in all 3 age groups: multiple R² = 0.40, estimate = 1.211e-05, p <0.0001. Mean/median PSA and age were 0.69/0.57 ng/dl and 35.6/37.2 years in 2003 and 1.04/0.66 ng/dl and 33.6/35.8 years in 2018.

The average baseline PSA is rising in young men. Changes in medical routine practice (e.g. reserving the test for those with higher suspicion) and a true rise in benign or pathological prostate conditions are possible reasons.