Age-Specific PSA Cut-Offs Avoid Unnecessary Prostate Biopsies in Older Men

Armen Hareyan's picture

Prostate Cancer Biopsies and PSA

A population study presented here in a moderated poster session at the European Association of Urology 22nd Annual Congress shows that the introduction of age-specific cut-offs for prostate-specific antigen (PSA) levels used in prostate cancer screening will reduce the number of unnecessary prostate biopsies in older men who naturally have higher levels of PSA than younger men.

The study was presented by David Connolly, MD, coinvestigator and research fellow in the Department of Urology at Belfast City Hospital in the United Kingdom. He told Medscape, "Northern Ireland is quite unique because we have a population-based database of all PSA tests in the whole country, so everybody who ever has a PSA [test] is on our database, and they are followed up through the [Northern Ireland] Cancer Registry to see whether or not they had a prostate biopsy [and] whether or not they were diagnosed with prostate cancer."

This analysis examined men who had their first PSA test between the beginning of 1994 and the end of 2000. The study followed the men in the registry to the end of 2003.


Of the 96,586 men included, 3537 (3.7%) had a confirmed diagnosis of prostate cancer during the study period. The mean (median) baseline serum PSA values of the control (no prostate cancer) and prostate cancer groups were significantly different: 4.5 (1.4) ng/mL and 148.4 (17.2) ng/mL (P < .001), respectively.

When the data was grouped according to 4 specific age categories, mean PSA levels for the control men increased significantly with increased age category: for men younger than 50 years, it was 1.2 ng/mL; 50 to 59 years, 1.8 ng/mL; 60 to 69 years, 3.1 ng/mL; and 70 years or older, 8.9 ng/mL (P < .001).

Across these age categories, the 95th percentile values were notably higher than established ranges: 2.5, 4.7, 8.3, and 17.8 ng/mL, respectively.

Although this study was not specifically designed to recommend new age-related cut-offs for prostate biopsy