Use of age-specific normal ranges for serum prostate-specific antigen

Area of Science:

• Urology
• Oncology
• Biochemistry

Background:

• The established normal range for prostate-specific antigen (PSA) is 0.0–4.0 ng/mL.
• Two alternative age-specific normal ranges for PSA have been proposed.
• These include ranges from Oesterling et al. and the Prostate Cancer Awareness Week initiative.

Purpose of the Study:

• To evaluate the effectiveness of age-specific normal ranges for PSA.
• To compare these ranges against the traditional normal range in biopsy-proven prostate adenocarcinoma cases.

Main Methods:

• A study of 213 consecutive biopsy-proven prostate adenocarcinoma cases.
• Analysis of patient age, disease stage, and serum PSA concentration at diagnosis.
• Application of three distinct PSA normal ranges (traditional and two age-specific) to each case.

Main Results:

• The traditional PSA range identified more elevated values across all stages compared to age-specific ranges.
• For stage II disease, the traditional range showed 78% elevated PSA, versus 66% (Oesterling et al.) and 67% (Prostate Cancer Awareness Week).
• In men aged 40–59, all three ranges yielded similar cancer detection rates (82%).

Conclusions:

• Age-specific PSA ranges may lead to missing over 10% of stage II prostate adenocarcinomas in men over 60.
• Clinical application of age-adjusted PSA ranges requires caution in older patient populations.
• Further research may be needed to refine PSA interpretation in diverse age groups.