title: Practice patterns of urologists in managing Korean men aged 40 years or younger with high serum prostate-specific antigen levels.
abstract: OBJECTIVE
  To investigate the practice patterns of urologists in managing Korean men aged 40 years or younger with high serum prostate-specific antigen (PSA).
  
  
  METHODS
  Data were collected from general health screenings conducted at 4 university hospitals between 2004 and 2012. Eligibility criteria were Korean men aged≤40 years who were seen by urologists for high PSA (>2.5 ng/mL). After excluding individuals with chronic prostatitis and any infectious symptoms and/or signs, the practice patterns of urologists managing 237 eligible men were analyzed.
  
  
  RESULTS
  The most common practice was observation after antibiotics (40.5%), followed by reassurance (38.4%), prostate biopsy (PBx) after antibiotics (11.8%), PBx after PSA follow-up (7.6%), and immediate PBx (1.7%). Antibiotics were prescribed empirically to 124 patients (52.3%). Of the entire patients, 145 of 237 (61.2%) had at least 1 follow-up PSA, and the follow-up PSA with median interval of 43 days (interquartile range, 26-149) was higher than initial PSA in 66 of 145 (45.5%). Of the 98 patients undergoing follow-up PSA after initial antibiotic treatment, 53 (54.1%) experienced a decline in PSA, whereas 45 (45.9%) experienced a rise in PSA. PBx was performed in 50 of 237 (21.1%), and only a single case (2%) of prostate cancer was diagnosed.
  
  
  CONCLUSIONS
  In managing men≤40 years with high PSA, the most common practice pattern was observation after antibiotic treatment despite lack of evidences. Furthermore, 1 in 5 urologists performed PBx to rule out cancer. Given the very low prevalence of cancer in this age group, clear guidelines are needed for appropriate management and consistency of care.
authors.affiliation: Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea.
authors.forename: Dae-Seon
authors.initials: DS
authors.lastname: Yoo
authors.affiliation: Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea.
authors.forename: Seung Hyo
authors.initials: SH
authors.lastname: Woo
authors.affiliation: Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Cho
authors.affiliation: Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Hanyang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Hanyang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Yul
authors.initials: SY
authors.lastname: Park
authors.affiliation: Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Jeon
authors.affiliation: Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea. Electronic address: jspark.uro@gmail.com.
authors.forename: Jinsung
authors.initials: J
authors.lastname: Park
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D011472:Prostatitis / Q000175:diagnosis* / Q000473:pathology; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D014572:Urology / Q000592:standards / Q000639:trends; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen