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Reliability of prostate-specific antigen evaluation according to age-specific range

In a recent paper by Oesterling et al, the authors stress the advantages of the use of age-specific reference ranges in interpreting the prostate-specific antigen (PSA) assay for clinical purposes. The authors suggest that age is strongly correlated with prostate volume, and that there is no need to assess the latter by transrectal ultrasonography (TRUS) to evaluate volume-adjusted PSA as this may be safely predicted by age. They propose a table of year-by-year age-specific reference ranges to be used in current practice. We have retrospectively evaluated a cohort of healthy males aged 60-74 years enrolled in a feasibility study of population-based screening by PSA or digital rectal examination (DRE) + TRUS (2). Although age was significantly correlated with both PSA and TRUSassessed prostate volume (Tab. I), the statistical variability was rather high, which would not permit a reliable prediction of the volume-dependent PSA value just on the basis of age in single subjects. If we had applied in our PSA screening study the age-specific reference range suggested by Oesterling et al (1) rather than the standard cutoff of 4 ng/ml, we would have reduced the recalls for DRE+TRUS assessment by 35% (5.77% vs 8.82%) but we would al-