Total, Free, and Percent Free Prostate-Specific Antigen Levels among U.S. Men, 2001-04

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Advance Data from Vital and

Health Statistics No. 379 + December 4, 2006

Number 379 + December 4,

2006

Total, Free, and Percent

Free Prostate-Specific Antigen Levels among U.S. Men, 2001–04

By A. Lacher, M.D.,

M.Ed., Centers for Disease Control and Prevention, National Center for Health

Statistics; Trevor D. , B.S., Centers for Disease Control and

Prevention, National Center for Chronic Disease Prevention and Health

Promotion; Jeffery P. , M.P.H., Centers for Disease Control and

Prevention, National Center for Health Statistics; and Mona Saraiya, M.D.,

M.P.H., Centers for Disease Control and Prevention, National Center for Chronic

Disease Prevention and Health Promotion

Abstract

Objective—Screening

for prostate cancer using prostate-specific antigen (PSA) tests is common but

remains controversial. Total PSA using thresholds of 4.0 and 2.5 ng/mL has been

used for screening men. In addition, the percent free PSA (free PSA/total PSA x

100%) using thresholds of less than 25% and 15% have been proposed for use in

screening for prostate cancer in conjunction with the total PSA. The distributions

of total PSA, free PSA, and percent free PSA, which vary with age and

race-ethnicity among American men, would help determine the burden of screening

using different thresholds of PSA tests.

Methods—PSA tests were

performed on serum samples from men age 40 years and older (n= 2,546) who

participated in the 2001–04 National Health and Nutrition Examination

Survey (NHANES). Total, free and percent free PSA were estimated for Mexican

American, non-Hispanic white, and non-Hispanic black men.

Results—About 6.2%,

(95% confidence interval, 95%

CI: 5.2–7.2%),

corresponding to an estimated 3.6 million (95% CI: 3.0–4.2 million) men

40 years of age and older, had a total PSA of greater than or equal to 4.0

ng/mL. Approximately 3.6% (95% CI:

1.8–6.2%) of Mexican American

men, 6.2% (95% CI:

5.1–7.6%) of

non-Hispanic white men, and 7.8% (95% CI: 5.2–11.1 ) of non-Hispanic

black men had total PSA of 4.0 ng/mL or more. Approximately

13.1 (95% CI:

11.7–14.5%) of men 40 years of age and older had total PSA greater than or

equal to

2.5 ng/mL. For men with

total PSA less than 2.5 ng/mL, 23.1% (95% CI: 21.0–25.3%) had a percent

free PSA between 15% and 25%, and 5.0% had free PSA (95% CI: 3.9–6.4%)

less than or equal to 15%.

Conclusions—The effect

of lowering the total PSA thresholds increases the number of U.S. men who

would be referred for screening for prostate cancer. Total and free PSA

increased with age in Mexican American, non-Hispanic white, and non-Hispanic

black men. Information about the distribution of total, free, and percent free

PSA will help guide public health policy in screening for prostate cancer.

Keywords: Prostate-specific

antigen c Prostate cancer screening c National Health and Nutrition Examination

Survey (NHANES)

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