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Objectives: To analyze the relationship of age and race to prostate-specific antigen (PSA) levels among participants in a community-based study., Methods: A total of 77,700 records of men aged 40 to 79 years were analyzed from a longitudinal study of PSA conducted during Prostate Cancer Awareness Week 1993 and 1994. Records from 1994 were not included for men who were tested in 1993. All cases of prostate cancer were excluded. Records with outlier PSA values greater than 20 ng/mL were eliminated from the analysis (n = 190; 24%)., Results: Mean PSA values (ng/mL) of 10-year age groups differed significantly (P < 0.0001) between each group (ages 40-49, 0.83; 50-59, 1.23; 60-69, 1.83; 70-79, 2.31). In each successively older age group, PSA variance increased significantly (P = 0.0001). Standard deviations (SD) by age group were: 40-49, 0.79; 50-59, 1.33; 60-69, 1.94; and 70-79, 2.35. Significant differences in mean PSA by race were found. Pairwise differences in mean PSA were found between whites and blacks, whites and Latinos, blacks and Asians, and Asians and Latinos (P < 0.0001). No statistically significant differences in PSA variance between racial groups were found. Age-within-race analysis resulted in consistent statistical significance when comparing variance among age cohorts in each race., Conclusions: Age-specific PSA reference ranges are a result of the increasing mean PSA and increasing PSA variance in successively older cohorts of men. Mean PSA values differ significantly by race, but differences in PSA variance do not. The clinical significance of race-specific PSA reference ranges has yet to be determined.

Ninety-one patients who underwent radical nephrectomy for renal cell carcinoma (RCC) were reviewed to determine the prognostic value of serum alkaline phosphatase (SAP) levels and radionuclide bone scan. A preoperative SAP greater than 127 IU/L was a strong indicator of eventual disease progression or death, and an elevated SAP was a better predictor of eventual outcome than bone scan.

A multicenter, randomized, double-blind study was undertaken to evaluate the efficacy of the antiandrogen flutamide in treating patients with urinary obstruction caused by benign prostatic hypertrophy (BPH). Patients were randomized to either flutamide (750 mg/d) or a placebo. Prostate size (measured by ultrasound), uroflow, and symptomatology were assessed in all patients. Of the 84 patients entered in the study, 30 receiving placebo have, to date, reached twelve weeks and 4 have reached twenty-four weeks. Twenty-eight patients receiving flutamide have reached twelve weeks, while 8 have reached twenty-four weeks. At twenty-four weeks, a 41 percent median decrease in prostate volume and a 46 percent increase in full-bladder uroflow was observed in patients receiving flutamide; no significant changes in prostate volume or uroflow occurred in patients receiving placebo. However, significant symptomatic improvements were noted in both groups. Only 4 patients (11%) had significant adverse reactions to flutamide; these reactions included breast pain and diarrhea. No cases of impotence occurred. It was concluded that flutamide may be a safe and effective drug for the treatment of symptomatic BPH.

Prader-Willi syndrome is characterized by eating abnormalities, infantile hypotonia, obesity, mental retardation, and hypogonadism. The causation of hypogonadism varies. We describe a patient with Prader-Willi syndrome whose hypogonadism is secondary to a hypothalamic defect. Individualization of patients with this syndrome is suggested. Based on the particular hormonal abnormality identified, a treatment plan can be constructed. Cryptorchidism should be approached in the usual fashion.