International Urology and Nephrology

, Volume 38, Issue 3–4, pp 559–564

Age-specific reference ranges for prostate specific antigen-total and free in patients with prostatitis symptoms and patients at risk

Original Article



Prostate-specific antigen (PSA) is a tumor marker helpful in the diagnosis and follow-up of prostate cancer. However, PSA level may rise due to other causes than prostate cancer such as benign prostatic hyperplasia (BPH), acute prostatitis, chronic bacteria and a bacterial prostatitis. Total serum PSA (TPSA) and free prostate-specific antigen (FPSA) levels of patients with prostatitis symptoms as well as these levels in male population at risk but without clinical prostatic diseases (>40-years-old) with regard to age should be documented in order to increase the sensitivity and specificity of PSA in prostate carcinoma.


A comprehensive urological examination was performed on 1150 male patients over the age of 40 with prostatism symptoms from the random-sample community based in with no diagnostic prostate cancer. Men with PSA level 4.1 ng/ml or greater were referred for biopsy and those with positive biopsies or with medical record, cancer registry, or self-reported evidence of prostate cancer were excluded. Data were studied as a function of age to determine the usefulness of measuring TPSA and FPSA as screening tests for risk patient’s cancer.


Because of the greater variability at older ages, the 95th percentile increased faster than the median, the following age-specific reference ranges of TPSA and FPSA for patients with prostatism symptoms were as follows: 3.1 and 0.7 ng/ml for the age group 40–49 years, 4.4 and 0.89 ng/ml for the age group 50–59 years, 5.6 and 1.3 ng/ml for the age group 60–69 years, and 6.3 and 1.8 ng/ml for age group 70–79 years. There was a continuous increase in TPSA and FPSA means and medians with significant correlation (< 0.001, < 0.005) and advancing age group. The aim of this study was to find out age-specific values and ranges of TPSA and FPSA in patients with prostatism symptoms to ensure low false-positive biopsy rates.


Specific reference ranges Total-, Free prostate-specific antigen and their ratio Prostatitis Prostatism 


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  1. 1.
    Nixon RG, Lilly JD, Liedtke RJ, Batjer JD (1997) Variation of free and total prostate-specific antigen levels: the effect on the percent free/total-specific antigen. Arch Pathol Lab Med Northfield 121(4):385–387Google Scholar
  2. 2.
    Catalona WJ, Smith TL, Ratliff et al (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324:1156–1161PubMedCrossRefGoogle Scholar
  3. 3.
    Oestrling JE (1991) Prostate-specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol 145:907–923Google Scholar
  4. 4.
    Jacobsen SJ, Katusic SK, Bergstraih et al (1995) Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing. JAMA 274:1445–1449PubMedCrossRefGoogle Scholar
  5. 5.
    Oestrling JE, Jacobsen SJ (1993) Serum prostate-specific antigen in community-based population of healthy men: establishment of age-specific reference ranges. JAMA 270:860–864CrossRefGoogle Scholar
  6. 6.
    Oesterling JE, Cooner WH (1993) Influence of patient age on serum PSA concentration. An important clinical observation. Urol Clin North Am 20:671–680PubMedGoogle Scholar
  7. 7.
    Hudson MA, Bahnson RR (1989) Clinical use prostate specific antigen in patients with prostate cancer. J.Urol 142:1011–1117PubMedGoogle Scholar
  8. 8.
    Resim S, Cez M, Gurbuz ZG, Fazlioglu A, Caskurlu T, Uras AR, Stevin G (1999) Serum PSA and age-specific reference ranges in patients with prostatism symptoms. Int Urol Nephrol 31(2):221–228PubMedCrossRefGoogle Scholar
  9. 9.
    Stamy TA, Yang N, Hay AR, Mcneal JF, Freiha FS, Redwine E (1987) Prostate-specific antigen as a serum marker for adenocarsenoma of the prostate. N Engl J Med 317:909–916CrossRefGoogle Scholar
  10. 10.
    Walsh PC (1993) Using prostate-specific antigen to diagnose prostate cancer: sailing in uncharted waters. Ann intern Med 119:984–949Google Scholar
  11. 11.
    Morgan TO, Jacobsen SJ, McCarthy WF, Jacobson DJ, MclacLeod DG, Moul JW (1996) Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med 335(5):304–310PubMedCrossRefGoogle Scholar
  12. 12.
    Armitage TG, Cooper EH (1988) The value of the measurement of serum prostate-specific antigen in patients with benign prostatic hypereplasis and untreated prostate cancer. Br J Urol 62:584–589PubMedCrossRefGoogle Scholar
  13. 13.
    Sershon PD, Barry MJ, Oestrling JE (1993) Serum PSA values in men with histologically confirmed BPH versus patients with organ-confined prostate cancer (abstract.). J␣Urol 149:421AGoogle Scholar
  14. 14.
    Catalona WJ, Richie JP, Ahmann FR et al (1994) Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6630 men. J Urol 151:1283–1290PubMedGoogle Scholar
  15. 15.
    Oestrerling JE, Chute CG (1993) Longitudinal changes in serum PSA (PSA velocity) in a community-based cohort of men (Abstract). J Urol 149:412AGoogle Scholar
  16. 16.
    Carter HB, Pearson JD (1992) Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 267:2215–2220PubMedCrossRefGoogle Scholar
  17. 17.
    Lange OH, Ercole CJ (1989) The value of serum prostate-specific antigen determinations before and after radical prostatectomy. J Urol 141:873PubMedGoogle Scholar
  18. 18.
    Osterling JE, Jacobsen SJ, Chute CG et al (1993) Serum prostate-specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges. JAMA 270:860–864CrossRefGoogle Scholar
  19. 19.
    Anderson JR, Strickland D, Corbin D, Byrnes JA, Zweiback E (1995) Age-specific reference ranges for serum prostate-specific antigen. Urology 46:54–57PubMedCrossRefGoogle Scholar
  20. 20.
    DeAntoni EP, Crawford ED (1995) Prostate cancer awarness week: education, service, and research in a community setting. Cancer 75:1874–1879CrossRefGoogle Scholar
  21. 21.
    Dalkin BL, Ahmann FR, Kopp JB (1993) Prostate specific antigen levels in men older than 50 years without clinical evidence of prostatic carcinoma. J Urol 150:1837–1839PubMedGoogle Scholar
  22. 22.
    el-Galley RES, Petro JA, Sanders WH et al (1995) Normal range prostatic-specific antigen versus age-specific prostate-specific antigen in screening prostate adenocarcinoma. Urology 46:200–204PubMedCrossRefGoogle Scholar
  23. 23.
    Niederau ChM, Beyrau R, Gurr E, Neumeier D, Peisker K, Raith H, Wood P, Domke I (1998) External evaluation of tumor markers on elesys 1010 immunoanalyzer. Tumor Marker Oncol 13(2):29–30Google Scholar
  24. 24.
    Steel RG, Torrie JH (1980) Principle and procedures of statistics. McGraw-Hill Book Co, New YorkGoogle Scholar
  25. 25.
    Benson MC, Whang IS, Pantuck A, Ring K et al (1992) Prostate-specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 147(3 Pt 2):815–816PubMedGoogle Scholar
  26. 26.
    Seamean E, Katz A (1993) An algorithm for prostate cancer detection based upon PSA TRUS, DRE, PSA density, and PSA velocity (Abstract). J Urol 149:414AGoogle Scholar
  27. 27.
    Riehman M, Rhodes PR (1998) Analysis of variation in prostate-specific antigen values. Urol 159:1243–1246CrossRefGoogle Scholar
  28. 28.
    Dalkin L, Ahman F (1993) Derivation of normal prostate specific antigen (PSA) level by age (Abstract). J Urol 149:413AGoogle Scholar
  29. 29.
    Battikhi MNG (2003) Age-specific reference ranges for prostate-specific (PSA) antigen in Jordanian patients. Prostate Cancer and Prostatic Dis 6:256–260CrossRefGoogle Scholar
  30. 30.
    Crawford ED (1993) Report on the 1992 Prostate Cancer Awareness Week (Abstract). J Urol 149:55AGoogle Scholar
  31. 31.
    Martin C, Weinrich A, Jacobsen ST et al (1998) Reference ranges for serum prostate-specific antigen in black and white men without cancer. Urology 52:967–973CrossRefGoogle Scholar
  32. 32.
    Sawyer R, Berman JJ, Borkowski A, William MG (1996) Elevated prostate-specific antigen levels in black men and white men. Mod Pathol 9:1029–1032PubMedGoogle Scholar
  33. 33.
    Hicks RJ (1993) Elevated prostate-specific antigen: a case report and analysis. J Fam Pract 37(3):284–288PubMedGoogle Scholar
  34. 34.
    Battikhi MN, Hussein I Serum prostate-specific antigen (PSA) in men without clinical evidence of prostate cancer. J Tumor Oncol Marker (In Press) Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  1. 1.Faculty of Allied Health Sciences, Department of Medical Laboratory SciencesHashemite UniversityZarqaJordan
  2. 2.Private clinic, Al-Razi polyclinicAmmanJordan

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