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SAMJ: South African Medical Journal

Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.101 n.9 Cape Town Sep. 2011




PSA results require age-related reporting



To the Editor: There is a concern that no cognisance appears to be taken of age-related normal ranges in reporting the results of total prostate specific antigen (PSA) tests in South Africa. This omission may result in many patients being subjected to unnecessary invasive procedures resulting in high costs to medical schemes and, more importantly, unnecessary prostate surgery.

South African private pathology laboratories do not reflect an age-related normal range for total PSA, unlike numerous other countries, e.g. Australia, Canada, the UK and the USA, who do so. Medicare in Australia will not reimburse claims for a free PSA if the total PSA result is not accompanied by the age-related normal range. South African laboratories have accepted that the upper limit of normality is 4 ng/ml, regardless of age. Workers in the USA have produced the following table:1



There are also racial differences in the normal ranges in the diverse South African population groups that appear not to have been considered.

Should the total PSA result exceed 4 ng/ml, the laboratories do a reflex test for free PSA and, should the age-related normal range not have been applied, an investigative cascade may commence unnecessarily. I submit that age-related tables should accompany all PSA total results.


D Sonnenfeld


1. Ward AM, Catto JW, Hamdy FC. Prostate specific antigen: biology, biochemistry and available commercial assays. Ann Clin Biochem 2001;38(part 6):633-651.         [ Links ]