Abstract 4954: Age- and race/ethnicity-specific values of prostate-specific antigen levels: Implications for prostate cancer screening

Background: A significant limitation in prostate cancer screening is the limited diversity and scope of data that have defined prostate-specific antigen (PSA) values. The use of PSA in prostate cancer screening could be enhanced with knowledge of the distribution of PSA in diverse groups of men. These data may inform triggers for clinical actionability, including biopsy. Objective: This study aims to evaluate the distribution of PSA values among healthy men of different ethnicities and age groups to derive age- and ethnicity-specific low, middle, and upper PSA distribution values. Methods: We meta-analyzed studies that reported PSA reference values in healthy men by age and self-identified race or ethnicity. The analysis was restricted to full text articles published in English. Participants were healthy men, aged 40-79 years with no history of prostate cancer, prostate disease, or prostate surgery. PSA values were not age-adjusted. We included data for either observed or estimated PSA values. Studies were excluded if they reported PSA in men with prostate cancer diagnosis, prostate disease, history of prostate surgery, suspicious DRE/TRUS values, age-adjusted results, or a small sample size (N<50). The primary outcomes of interest were to estimate PSA values to construct age- and race-stratified PSA values. Estimates were calculated for the upper limits of the following percentiles: 5th, 10th, 25th, 50th, 75th, 90th, and 95th for 16 race/ethnicity groups. Results were stratified by the original exclusion criteria used by the individual studies, including 1) PSA>4.0 ng/ml, Suspicious DRE/TRUS; or 2) history of prostate disease, surgery, or cancer. Forty-two studies met our criteria and were included in this report. Results: Men of African descent had higher PSA values followed by men of Asian and European descent. Within the 95th percentile, African descent men had PSA estimates of 4.78 ng/ml, 5.47 ng/ml, 8.93 ng/ml. White men had PSA values of 1.90 ng/ml, 2.06 ng/ml, and 3.31 ng/ml respectively for 40-49 years, 50-59 years, and 60-69 years. When stratified, the distribution of PSA was overall higher among those studies which excluded based on PSA levels greater than 4.0 ng/ml compared to studies which excluded based on history or prostate disease, surgery, or cancer; for both race and age. However, Japanese men had higher a higher distribution compared to African descent men for all ages in the 95thpercentile among those with no history of prostate disease, surgery, or cancer. Conclusion: We report an association of PSA levels with race and age. PSA was elevated among men of African descent and increase with age. Our data may inform the use of PSA in screening for prostate cancer in diverse populations Citation Format: Pranoti Pradhan, Timothy R. Rebbeck, William K. Oh, Sigrid Carlsson, Kevin H. Kensler. Age- and race/ethnicity-specific values of prostate-specific antigen levels: Implications for prostate cancer screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4954.