Elevated Prostate Specific Antigen is Associated with Prostate Disease, Lower Urinary Tract Symptoms, and Erectile Dysfunction: Findings from 5325 Men.

Background: Prostate specific antigen (PSA) testing is widely used for detection and monitoring of prostate disease. Age-specific thresholds are applied to improve clinical interpretation of PSA results. However, the demographic and clinical characteristics associated with elevated PSA in large population-based cohorts remain incompletely understood. Methods: A cohort of 5325 men underwent PSA testing applying NICE (NG12) age-specific thresholds. Participants were then classified as having normal or elevated PSA concentrations. Demographic characteristics, BMI, self-reported prostate disease, erectile dysfunction (ED), and lower urinary tract symptoms (LUTS) were compared between groups. Results: Of 5325 participants, n=186 (3.5%) had elevated PSA concentrations and n=5139 (96.5%) had PSA levels within the age-specific reference range. The prevalence of elevated PSA increased with age, with men aged 50-69 years representing 73% (136/186) of all elevated PSA cases. Men with elevated PSA had a higher median BMI and were more likely to be obese. A previous diagnosis of prostate disease was reported by 17% of men with elevated PSA compared with 2.9% of those with normal PSA. ED and LUTS were common among participants with elevated PSA. Conclusion: Elevated PSA concentrations were identified in a small proportion of men but were strongly associated with age, BMI, previous prostate disease, ED, and LUTS. These findings demonstrate that elevated PSA is associated with a clinically meaningful burden of urological symptoms and prostate disease-related morbidity. Future studies should evaluate independent predictors of elevated PSA and the utility of combining PSA measurements with symptom-based risk assessment for the identification of clinically significant prostate disease.