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Normal range prostate-specific antigen versus age-specific prostate-specific antigen in screening prostate
R E el-Galley1, J A Petros, W H Sanders
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Urology
|August 1, 1995
Summary
Age-adjusted prostate-specific antigen (PSA) ranges improve prostate cancer screening accuracy. This method increases sensitivity in younger men and reduces unnecessary biopsies in older men, enhancing diagnostic value.
Area of Science:
- Urology
- Oncology
- Biomarker Research
Background:
- Prostate-specific antigen (PSA) is a key serum tumor marker for prostate cancer.
- Current PSA reference ranges (0-4.0 ng/mL) have limitations in sensitivity and specificity.
- Age-adjusted PSA aims to improve screening by considering prostate size changes with age.
Purpose of the Study:
- To evaluate the effectiveness of age-specific PSA ranges compared to the standard range.
- To determine the sensitivity, specificity, and positive predictive values of different PSA screening strategies.
- To assess the impact of age-adjusted PSA on biopsy rates.
Main Methods:
- Analysis of 5,629 transrectal ultrasound (TRUS) examinations from 4,710 men (1987-1994).
- Comparison of standard PSA ranges (0-4 ng/mL) with age-specific PSA values.
- Patient stratification into age groups by decade (40-49, 50-59, 60-69, 70-79 years).
Main Results:
- Biopsies were performed in 2,657 patients, with 35.6% testing positive for cancer.
- Criteria for biopsy included elevated PSA, PSA density > 0.15, abnormal digital rectal exam (DRE), or suspicious TRUS.
- Patient data was analyzed across four age groups.
Conclusions:
- Age-specific PSA ranges enhance screening sensitivity in younger men.
- Utilizing age-adjusted PSA decreases the biopsy rate in older men, potentially avoiding unnecessary procedures.
- Age-adjusted PSA is particularly beneficial for men over 70, potentially sparing 22% from TRUS with biopsy.