Serum Prostate-Specific Antigen in a Community-Based Population of Healthy Men

Targeted screening for prostate cancer in African-American men

“…For comparison, the Papanicolaou smear for cervical cancer, which is an accepted clinical screening test, has a ROC value of 0.70. When we calculated age-speci®c reference ranges by the identical methodology of Oesterling and colleagues used in their 1993 study of primarily Caucasian patients from Olmstead County, Minnesota, 51 we found very similar values for white men but higher values for black men. These ranges were 0 ± 2.4 ng/ml for black men aged 40 ± 49, 0 ± 6.5 ng/ml for men aged 50 ± 59, 0 ± 11.3 ng/ml for men aged 60 ± 69, and 0 ± 12.5 ng/ml for men aged 70 ± 79.…”

“…Clinicians screening black (and white) men for prostate cancer currently have a wide choice of PSA thresholds to consider including the traditional 4.0 ng/ml for everyone, the Mayo Clinic age-adjusted ranges, 51 the Walter Reed/ Center for Prostate Disease Research ranges, 50 a 2.5 ng/ ml cut-off point along with percentage free PSA advocated by Catalona et al, 58 or the 2.0 ng/ml threshold advocated by Littrup from Wayne State for all AfricanAmerican men. 52 Perhaps more important than`splitting hairs' about these subtle differences in PSA level, the key factor may be initiating screening at a younger age (40 ± 45 y) and following through with periodic sequential testing during a window of opportunity (ie 40 ± 60 or 45 ± 65 y, as an example).…”

How to use prostate-specific antigen in the early detection or screening for prostatic carcinoma

“…2). Figure 5 demonstrates this phenomenon, using various age-specific cutoffs as suggested by Oesterling et al 50 Note that in addition to increase in PPV with increasing PSA cutoffs, there is a concomitant increase in cancer found as men age-owing to the increased prevalence of prostate cancer.…”

“…It should be noted that the use of 4.0 ng/ml as the upper limit of normal for the Hybritech assay was based on the observation that in men apparently free of prostatic disease, this value represented the 95 percent confidence interval. 49 Oesterling et al 50 and Dalkin et al 51 noted that this definition was probably inappropriate for the upper limit of normal. They used very well-characterized patient populations apparently free of carcinoma (as evidenced by either PSA level less than 4.0 ng/ml and a normal DRE…”

“…They reported the 95th percentile for each decade. 50,51 Oesterling et al 50 defined the agespecific reference range for serum PSA to be 0.0 to 2.5 ng/ml for men aged 40 to 49 years, 0.0 to 3.5 ng/ml for men aged 50 to 59 years, 0.0 to 4.5 for men aged 60 to 69 years, and 0.0 to 6.5 for men aged 70 to 79 years. Furthermore, these authors concluded that using such age-specific cutoffs would result in improved sensitivity for younger men and improved specificity for older men.…”