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ABSTRACT Objectives: While controversial, the use of prostate specific antigen (PSA) testing is common and may reduce the morbidity and mortality associated with prostate cancer. The use of age-specific reference ranges (ASRRs) has been suggested to increase the sensitivity of the PSA test in younger men. The objective of this study was to determine the normal age-specific reference ranges for a large group of clinically cancer-free men and to compare these findings with similar studies. Materials and Methods: A retrospective chart review of PSA values was conducted on 1199 students from the National Defense University, Fort McNair, Washington, DC, who were matriculating between 1994 and July 1999. The AsXYM system using MEIA technology with monoclonal antibodies from Abbott laboratories was used to determine the PSA values. The mean, median, 95th percentile, 99th percentile, and range were calculated for each decade. Results: A total of 1123 students between the ages of 30 and 59 were included in the study (1105 with PSA levels ≤ 4.0 ng/ml). The largest number of students (67.4%) fell in the 40–49-year-old group. The median PSA level was 0.74 ng/ml. There was a significant correlation between age and PSA level for the 40–59-year-old age group (r = 0.06, p = 0.044). There was no significant correlation between age and PSA for the 40–49-year-old age group (r = 0.048, p = 0.192). The median PSA value and the 95th percentile increased from 0.7 and 2.3, respectively, in the 40–49-year-old age group to 0.8 and 2.7, respectively, in the 50–59-year-old age group. Conclusions: The results of this study indicate that PSA values in young men are quite low. The 95th percentile of PSA levels for men in their 40s and 50s was 2.3 and 2.7 ng/ml, respectively, which is significantly lower than the traditional normal value of 4.0 ng/ml. Although further prospective studies are needed, our data suggest that a lower PSA value threshold of... [ABSTRACT FROM AUTHOR]

The diffusion of early detection of prostate cancer with the prostate-specific antigen (PSA) test and subsequent aggressive treatment for the cancers discovered, in the absence of randomized trials documenting such screening efforts do more good than harm, has been nothing short of remarkable in the United States. The decade of the 1990s in this country might appropriately be referred to as the "PSA era." The medical and social reasons for the success of this strategy are complex. They include a captivating pathophysiologic rationale, "proof of concept" that early detection saves lives with screening for breast cancer in women, economic incentives for physicians and industries involved with testing and treatment, medicolegal concerns relating to failure to diagnose prostate cancer, positive feedback from grateful patients who feel reassured based on their test results, and even stronger positive feedback from prostate cancer survivors who are sure they have "beaten cancer" as a result of early detection--many of whom would never have even known they had prostate cancer in the "pre-PSA" era. Even the U.S. Postal Service has gotten into the business of screening recommendations in this area with a 1999 postage stamp urging "Annual Check-Ups and Tests" for prostate cancer. [ABSTRACT FROM AUTHOR]