Determining age-specific prostate-specific antigen for healthy Indian men: A retrospective study

Introduction: Prostate cancer usually affects older men and accounts for considerable cancer-associated mortality in men globally. In India, there is a rise in prostate cancer, and the published literature to determine age-specific prostate-specific antigen (PSA) is limited by a small sample size. The objective of our study was to determine age-specific PSA for Indian men based on a very large cohort of apparently healthy men undergoing health screening. Methods: This was a retrospective study using the hospital-based database of men who had undergone PSA blood tests as a part of health screening at two tertiary referral centers in South India between January 1, 2011, and August 31, 2018. Anonymous data were extracted, and statistical analysis was performed. Results: During this period, 99,386 men underwent PSA blood tests. Non-Indian patients and patients with PSA levels either <0.2 or >20 were excluded from the study, leaving 86,728 patients who were further analyzed. Seventy percent of patients were below 60 years of age, and the mean PSA for the study cohort was 1.2 ng/mL (standard deviation 1.74), with a median PSA of 0.7 ng/mL (interquartile range 0.4-1.1). The 95th percentile serum PSA level was 1.40, 1.70, 3.10, 5.80, 8.82, and 11.31 ng/mL for age groups of <= 40, 41-50, 51-60, 61-70, 71-80, and >80 years, respectively. The mean, median, and 95th percentile PSA reportedly increased for each decade of life (P = 0.0005). Conclusions: Results of this study indicated a positive correlation between serum PSA level and age in Indian men. These values are lower than the age-specific PSA defined for Caucasian men. These findings provide a basis for establishing new age-specific reference ranges of PSA for Indian men which will help in clinical decision-making.