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Related Experiment Videos

Age-specific reference ranges for serum prostate-specific antigen in black men

T O Morgan1, S J Jacobsen, W F McCarthy

  • 1Department of Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.

The New England Journal of Medicine
|August 1, 1996
PubMed
Summary

Prostate-specific antigen (PSA) screening for prostate cancer requires race-specific reference ranges. Traditional ranges miss over 40% of prostate cancer cases in black men, necessitating adjusted ranges for accurate detection.

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Area of Science:

  • Urology
  • Oncology
  • Medical Diagnostics

Background:

  • Prostate-specific antigen (PSA) screening is crucial for prostate cancer detection.
  • Current age-specific PSA reference ranges are based on white populations, potentially limiting accuracy in other racial groups.
  • Understanding PSA distribution across different races and age groups is vital for effective screening.

Purpose of the Study:

  • To determine the distribution of PSA levels and establish age-specific reference ranges in black men.
  • To compare PSA levels and reference ranges between black and white men with and without prostate cancer.
  • To assess the impact of using traditional versus race-specific PSA reference ranges on prostate cancer detection rates in black men.

Main Methods:

  • Serum PSA levels were measured in a large cohort of white and black men, including those with and without diagnosed prostate cancer.

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  • Data analysis considered age and race to evaluate the diagnostic utility of PSA.
  • Receiver-operating-characteristic (ROC) curves were used to assess test performance.

    • Main Results:

    • Black men exhibited significantly higher serum PSA concentrations compared to white men.
    • Traditional age-specific PSA reference ranges, if applied to black men with 95% specificity, would miss 41% of prostate cancer cases.
    • Adjusted reference ranges for black men were proposed to achieve 95% sensitivity, with varying specificity across age groups.

    Conclusions:

    • Serum PSA effectively discriminates between prostate cancer patients and controls in both black and white populations.
    • Traditional PSA screening ranges are inadequate for black men, leading to a high rate of missed diagnoses.
    • Implementing race-specific reference ranges, prioritizing sensitivity, is recommended for improved prostate cancer detection in high-risk black populations.