Practice Patterns of Urologists in Managing Korean Men Aged 40 Years or Younger With High Serum Prostate-specific Antigen Levels

Objective To investigate the practice patterns of urologists in managing Korean men aged 40 years or younger with high serum prostate-specific antigen (PSA). Materials and Methods Data were collected from general health screenings conducted at 4 university hospitals between 2004 and 2012. Eligibility criteria were Korean men aged ≤40 years who were seen by urologists for high PSA (>2.5 ng/mL). After excluding individuals with chronic prostatitis and any infectious symptoms and/or signs, the practice patterns of urologists managing 237 eligible men were analyzed. Results The most common practice was observation after antibiotics (40.5%), followed by reassurance (38.4%), prostate biopsy (PBx) after antibiotics (11.8%), PBx after PSA follow-up (7.6%), and immediate PBx (1.7%). Antibiotics were prescribed empirically to 124 patients (52.3%). Of the entire patients, 145 of 237 (61.2%) had at least 1 follow-up PSA, and the follow-up PSA with median interval of 43 days (interquartile range, 26-149) was higher than initial PSA in 66 of 145 (45.5%). Of the 98 patients undergoing follow-up PSA after initial antibiotic treatment, 53 (54.1%) experienced a decline in PSA, whereas 45 (45.9%) experienced a rise in PSA. PBx was performed in 50 of 237 (21.1%), and only a single case (2%) of prostate cancer was diagnosed. Conclusion In managing men ≤40 years with high PSA, the most common practice pattern was observation after antibiotic treatment despite lack of evidences. Furthermore, 1 in 5 urologists performed PBx to rule out cancer. Given the very low prevalence of cancer in this age group, clear guidelines are needed for appropriate management and consistency of care.