title: Prostate cancer in patients with screening serum prostate specific antigen values less than 4.0 ng/dl: results from the cooperative prostate cancer tissue resource.
abstract: OBJECTIVE
  Prostate cancer can occur in patients with low screening serum prostate specific antigen (PSA) values (less than 4.0 ng/ml). It is currently unclear whether these tumors are different from prostate cancer in patients with high PSA levels (greater than 4.0 ng/ml).
  
  
  METHODS
  From the Cooperative Prostate Cancer Tissue Resource database through March 2004, 3,416 patients with screening PSA less than 16.0 ng/ml diagnosed with prostate cancer between 1993 and 2004 were stratified in groups based on screening serum PSA. These subsets were compared for race, age at diagnosis, clinical and pathological stage, Gleason score, positive surgical margins, posttreatment recurrent disease, and vital status.
  
  
  RESULTS
  We identified 468 (14%) patients with screening PSA less than 4.0 ng/ml, 142 (4.2%) of whom had a PSA of less than 2.0 ng/ml. This group included 40 black and 376 white patients. Men with low screening PSA treated with radical prostatectomy had smaller cancers, lower Gleason scores, lower pathological tumor (T) stage and lower PSA recurrence rates than men with high PSA levels (4 ng/ml or greater). These differences held true for men who were younger than 62 years or were white, whereas older or black men had tumor characteristics and outcomes similar to those with higher PSA levels.
  
  
  CONCLUSIONS
  Young (younger than 62 years) or white patients with screening serum PSA less than 4.0 ng/ml had smaller, lower grade tumors and lower recurrence rates than patients with PSA 4.0 ng/ml or greater. This was not true for those older than 62 years and for black men.
authors.affiliation: Departments of Pathology, New York University School of Medicine, New York, New York, USA.
authors.forename: Milton W
authors.initials: MW
authors.lastname: Datta
authors.forename: Rajiv
authors.initials: R
authors.lastname: Dhir
authors.forename: Kevin
authors.initials: K
authors.lastname: Dobbin
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Bosland
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Becich
authors.forename: Jan M
authors.initials: JM
authors.lastname: Orenstein
authors.forename: André A
authors.initials: AA
authors.lastname: Kajdacsy-Balla
authors.forename: Ashok
authors.initials: A
authors.lastname: Patel
authors.forename: Virgilia
authors.initials: V
authors.lastname: Macias
authors.forename: Jules J
authors.initials: JJ
authors.lastname: Berman
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen