title: PSA quo vadis? It is reasonable to start with prostate-specific antigen testing at the age of 40!
abstract: BACKGROUND
  It is common to start with PSA (prostate-specific antigen)-testing at the age of 50. If patients with a PSA value greater than 4 ng/mL should be considered for prostate biopsy, approximately 20% of all men undergoing test are considered for biopsy at the time of first early-detection examination.
  
  
  METHODS
  We have screened 2,592 asymptomatic men younger than 45 years. With a short questionnaire, we assessed age, body mass index (BMI), concomitant diseases, last sexual intercourse, and last bicycle riding. We compared this cohort with a group of 11,656 men aged 45-75 years from a nationwide prostate cancer screening trial.
  
  
  RESULTS
  In this cohort, only 4 men with a PSA value greater than 4 ng/mL and 10 with a PSA greater than 3 ng/mL were identified. More than 99% of all men younger than 45 years had a PSA lesser than 4 ng/mL. Sexual intercourse, bicycle riding, or BMI had a significant but minimal influence on the PSA value.
  
  
  CONCLUSIONS
  It is reasonable to start with PSA testing at the age of 40 years. The advantage of screening younger patients is that almost no one should be considered for biopsy at the time of first early-detection examination. We identified a baseline value at which only a minimal influence was exerted by benign prostatic hypertrophy. In comparison with many current guidelines, we gained a lead time of 10 years for observation of PSA dynamics.
  
  
  CONCLUSIONS
  The importance of PSA velocity for stratification of patients at risk for development of significant prostate cancer will grow.
authors: Department of Urology and Urooncology, University of Essen , Essen, Germany. christof.boergermann@krankenhaus-dueren.de
authors: Christof
authors: C
authors: Börgermann
authors: Frank
authors: F
authors: vom Dorp
authors: Andreas
authors: A
authors: Swoboda
authors: Oskar
authors: O
authors: Ketteniss
authors: Markus
authors: M
authors: Becker
authors: Herbert
authors: H
authors: Rübben
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015992:Body Mass Index; D016022:Case-Control Studies; D042241:Early Diagnosis; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen