Over 48,000 baseline prostate-specific antigen measurements in young men: a 16-year time-analysis.

Introduction: To broaden our understanding of baseline PSA variations over the last decades in men under 40 years old.

Material and methods: We analysed the baseline total PSA of 48,896 men below the age of 40 years, grouped into 3 age groups: <30 (n = 6,123), 30-35 (n = 16,118), and >35 (n = 25,351) years old. Multiple linear regression model predicted the average LogPSA per month as a function of time, age, and testing rate during the 16-year period of the data (2003-2018).

Results: The average age and standard deviation were 34.5 ±4.6 years, and the median PSA ± interquartile range was 0.63 ±0.46 ng/dl with a leftward skew towards zero (81% of results below 1 ng/dl) in all years. The average LogPSA was steadily rising over time, independent of age and testing rate in all 3 age groups: multiple R² = 0.40, estimate = 1.211e-05, p <0.0001. Mean/median PSA and age were 0.69/0.57 ng/dl and 35.6/37.2 years in 2003 and 1.04/0.66 ng/dl and 33.6/35.8 years in 2018.

Conclusions: The average baseline PSA is rising in young men. Changes in medical routine practice (e.g. reserving the test for those with higher suspicion) and a true rise in benign or pathological prostate conditions are possible reasons.