Elevated Prostate Specific Antigen is Associated with Prostate Disease, Lower Urinary Tract Symptoms, and Erectile...

Prostate specific antigen (PSA) testing is widely used for detection and monitoring of prostate disease. Age-specific thresholds are applied to improve clinical interpretation of PSA results. However, the demographic and clinical characteristics associated with elevated PSA in large population-based cohorts remain incompletely understood.

A cohort of 5325 men underwent PSA testing applying NICE (NG12) age-specific thresholds. Participants were then classified as having normal or elevated PSA concentrations. Demographic characteristics, BMI, self-reported prostate disease, erectile dysfunction (ED), and lower urinary tract symptoms (LUTS) were compared between groups.

Of 5325 participants, n=186 (3.5%) had elevated PSA concentrations and n=5139 (96.5%) had PSA levels within the age-specific reference range. The prevalence of elevated PSA increased with age, with men aged 50-69 years representing 73% (136/186) of all elevated PSA cases. Men with elevated PSA had a higher median BMI and were more likely to be obese. A previous diagnosis of prostate disease was reported by 17% of men with elevated PSA compared with 2.9% of those with normal PSA. ED and LUTS were common among participants with elevated PSA.

Elevated PSA concentrations were identified in a small proportion of men but were strongly associated with age, BMI, previous prostate disease, ED, and LUTS. These findings demonstrate that elevated PSA is associated with a clinically meaningful burden of urological symptoms and prostate disease-related morbidity. Future studies should evaluate independent predictors of elevated PSA and the utility of combining PSA measurements with symptom-based risk assessment for the identification of clinically significant prostate disease.