Original article
Sixteen-Year Longitudinal Changes in Serum Prostate-Specific Antigen Levels: The Olmsted County Study

https://doi.org/10.1016/j.mayocp.2011.09.002Get rights and content

Abstract

Objective

To determine the distribution of longitudinal changes in serum prostate-specific antigen (PSA) levels from a population-based sample of men.

Patients and Methods

In this prospective cohort study, a random sample of Olmsted County, Minnesota, men aged 40 to 79 years in 1990 were followed up biennially from January 1, 1990, through August 29, 2007. Serum PSA levels were determined at each examination, and men were censored for follow-up with a diagnosis of prostate cancer or treatment for benign prostatic hyperplasia. The empirical distributions of annual percent change and annual absolute change in serum PSA level were calculated and tabulated, including the median and 75th and 95th percentiles.

Results

For men with PSA measurements 2 years apart, the median annual percent change in serum PSA level was 4.83% and the 95th percentile was about 49.76%. The variability in estimated annual change decreased with increasing time between assessments, with a 95th percentile of 21.82% after 8 or more years between assessments. Although the median absolute change per year increased with increasing age, the median percent change per year was fairly consistent across age groups.

Conclusion

These data demonstrate that, with shorter intervals between assessments, greater variability should be expected. These distributions should prove helpful to patients and clinicians in interpreting changes in serum PSA levels observed in typical clinical practices.

Section snippets

Study Participants

The Mayo Clinic Institutional Review Board and the Olmsted Medical Center Institutional Review Board approved this study.

Specific information regarding the study has been detailed previously.16, 17, 18 To summarize, in 1990, white men between 40 and 79 years of age residing in Olmsted County, Minnesota, were identified through the Rochester Epidemiology Project. Potential participants were excluded on the basis of having previous prostate surgery or prostate cancer diagnosis or specific

Results

Serum PSA levels at baseline increased with increasing decade of age. The median serum PSA levels were 0.7, 0.9, 1.4, and 2.1 ng/mL for men in their 40s, 50s, 60s, and 70s, respectively, and were similar to those used in the development of previously reported age-specific reference ranges,18 but also include the participants used as replacements in follow-up.

In Table 1 and Figure 1, the annual percent change in serum PSA level for the entire cohort is presented, stratified by intervening time.

Discussion

In this report we describe distributions of changes in serum PSA levels that may help physicians and patients make sense of changes they observe in real life. These normative values give a sense of an upper limit of normal, providing insight into the specificity of change in PSA level in the detection of prostate cancer (ie, level at which the change correctly identifies men without cancer). We demonstrate that change is best described in terms of a percent change rather than an absolute change

Conclusion

We determined the normal variability in a serum PSA level in a cohort of white men who were studied systematically at 2-year intervals. These data may prove helpful to patients and clinicians in interpreting changes in serum PSA levels observed in typical practices. Men with rapidly increasing PSA levels should be evaluated more closely to determine whether the unusually rapid increase could be due to a benign acute condition or whether a prostatic biopsy should be scheduled.

Acknowledgement

The authors thank Ms Tina Condon for assistance in the preparation of the submitted manuscript and Ms Marcia Goodmanson for providing laboratory oversight and running many of the serum PSA assays.

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    • Cited by (0)

    Grant Support: This study was supported in part, by grants from the National Institutes of Health (DK058859, AG034676, AR030582, and RR000585) and Merck Research Laboratories.

    Potential Competing Interests: Dr Girman is an employee of and a shareholder in Merck Research Laboratories. Dr Klee has received research grants and royalties for unrelated technologies from Beckman Coulter, Inc. Dr Jacobsen has received research grants from Beckman Coulter, Inc.

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