“Normal” (reference) PSA values among Spanish males under 65 years of age

Between January 1 and December 31, 2006, a recently reported study sought to determine age-based reference PSA values for men in various regions of  Spain who had no history of prostate problems.

Gelpi-Méndez et al. have published data from a study of over 65,000 Spanish men aged from less than 40 up to a maximum of 64 years of age. Their goal was to define age-associated reference PSA values among these men, none of whom had reported any history of prostate problems.

The results of this study are as follows:

  • For men aged < 40 years, the average (mean) PSA value was 0.67 ± 0.49 ng/ml.
  • For men aged 40-49 years, the average (mean) PSA value was 0.77 ± 0.66 ng/ml.
  • For men aged 50-59 years, the average (mean) PSA value was 1.11 ± 1.22 ng/ml.
  • For men aged 60-64 years, the average (mean) PSA value was 1.57 ± 1.72 ng/ml.
  • The overall average (mean) PSA value for all men in the study was 1.06 ± 1.18 ng/ml.
  • The overall average (mean) PSA value for all men in the srudy varied by region from a low of 0.98 ± 1.02 ng/ml (in the País Vasco) to a high of 1.28 ± 1.32 ng/ml (in Asturias).
  • The upper limit (95th percentile) for “normal” PSA values by age were 1.40 ng/ml in men of <40 years; 1.70 ng/ml in men of 40-49 years; 3.30 ng/ml in men of 50-59 years; and 5.18 ng/ml in men of 60-64 years.

These data provide no insight into the risk for the presence of prostate cancer among these men, who had no clinical indication of any prostate problem. However, they do give some insights into what might be considered as a reasonable range of “normal” PSA levels for Spanish males at certain ages, and they therefore have implications for the possible justification for biopsy of Spaniards with PSA levels that exceed the normal ranges. Whether these data have any relevance to Hispanic males in other countries is not known.

6 Responses

  1. “…… they therefore have implications for the possible justification for biopsy of Spaniards with PSA levels that exceed the normal ranges.”

    Huh? You mean that elevated PSA levels above a “normal” level are consistently associated with PCa to the extent that a biopsy is justified?

    Has it not already been established in a good US study that if you biopsy men with a PSA below 4.0 ng/ml you’ll find about 15% will be diagnosed with what we currently term prostate cancer?

    Perhaps you are suggesting that the 15% strike rate would only be in those men with PSA levels above the norm?

    But then didn’t that same study find that prostate cancer might be diagnosed in men with virtually undetectable PSA levels.

    Oh, this is SO confusing. My head is spinning.

  2. Terry:

    I am not making any decisions of the type you suggest, or specifying any particular consequences. I am merely pointing out that the sorts of implications you refer to are affected by these data in the Spanish population.

  3. What does Terry mean by “what we currently term prostate cancer?”

  4. Tracy,

    Definitions change from time to time. For example there was a significant change in January this year when there was a general agreement among the pathologists the key points of which are summarized on my website at http://www.yananow.net/StrangePlace/forest.html#gleason

    I first became aware of the fact that not all “cancers” are equal when I read the transcript of a speech given by Dr Christopher Logthetis in 1993. A leading expert in advanced prostate cancer, he was asked a question at a US TOO meeting in Texas. He had been commenting on the relative inaccuracy of the diagnostic process. The question was: “Does this mean that a lot of people who are diagnosed as having cancer really don’t?” His answer was: “Yes, if one accepts the diagnosis that the cancer is a disease that is potentially lethal …. One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It’s sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don’t have anything to do with reality. And they are only worrisome because the pathologist has decided to call it a cancer.”

    Leading pathologist Dr Jonathon Oppenheimer also has a strong view on the subject, saying, in 2008:

    “It is time to reconcile the discrepancy of the term that pathologists assign to a microscopic finding to the historical and practical significance of that term. The most common significant finding made by contemporary pathologists on prostate biopsies cannot be adequately described by ‘tumor’ (Greek: swelling), ‘cancer’ (from the crab-like extension), or ‘malignant’ (threatening to life or tending to metastasize). I propose the terms ‘prostatic tubular neogenesis’ (creation of new epithelial tubes or acini) and ‘potentially malignant’ to better describe the microscopic findings that we have in the past labeled ‘adenocarcinoma,’ ‘cancer,’ ‘tumor,’ and ‘malignant.’

    My personal belief is that if we discriminated between low-risk prostate cancer and the more aggressive forms by using different nomenclature for the former, there would be a signficant reduction in the over-treatment that has seen hundreds of thousands of men lose their quality of life for no good reason.

  5. Why are Spanish average PSA values so much lower than UK average PSA values?

  6. Who knows? Genetics, diet, lifestyle, you name it. … Or maybe it is just the widespread use of different “standard” PSA tests in Spain compared to the UK.

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