EAU 2025: The Potential Diagnostic Impact of Complying with Recommended Age-specific PSA Cut-off Values in Clinical Practice

Introduction

The recommended prostate-specific antigen (PSA) value for starting further assessment with diagnostic tools such as magnetic resonance imaging (MRI) and biopsy is still controversial. In the United Kingdom, there have been following age specific PSA ranges:

There is a potential to miss men that have undiagnosed prostate cancer therefore the diagnostic impact of following the above mentioned age-specific threshold on the potential to miss intermediate and high-risk prostate cancer is analysed in this study.

Materials and Methods

The pathological reports of 1703 men who had radical prostatectomy from 2012 to 2023 and who had a Gleason score of ≥7 or A International Society of Urological Pathology (ISUP) grade 2 TO 5 were reviewed. During this duration further diagnostic tests like MRI and biopsy were performed if PSA threshold of 3 ng/mL was crossed or if a palpable lesion was seen on digital rectal examination (DRE). The patients with PSA values below the age-specific threshold were identified and proportions of men that potentially would have been missed were calculated. 

Results

Study Population: Total radical prostatectomy cases: 1703