Age-specific PSA reference values based on a screening population of British men

Summary 

Objective

Age-specific PSA reference values are recommended by the Department of Health and NICE as a referral trigger for men with abnormal PSA values. They are arbitrary values in the UK and are based on the international literature.

Patients and methods

Data of 1970 men with benign histology from the Gwent screening study were used out of a cohort of 2063 men. The adaptive trimmed maximum likelihood method as the best way of removing outliers which do not come from a log-normal distribution was used after data transformation. The 95% percentile was used as cut-off value.

Results

The true statistical 95% percentile for PSA in a screening population for the age groups 50–59.9 years, 60–69.9 years and 70–79.9 years are 3.2ng/ml, 5.6ng/ml and 8.1ng/ml, respectively.

Conclusions

These values differ from the recommended referral cut-off values by the Department of Health. The adoption of higher values for the older age groups may be a sensible policy to avoid unnecessary investigation in elder men with high PSA values due to benign disease.

Abbreviations: DRE, digital rectal examination, GP, general practitioner, NICE, National Institute for Clinical Excellence, PSA, prostate specific antigen, TRUS, transrectal ultrasound

Keywords: Prostate cancer, PSA, Age-specific PSA, Prostate neoplasm, PSA screening