To reveal the pattern of change of the prostate-specific antigen (PSA) level in asymptomatic men younger than 45 years whose PSA level was ≥4.00ng/ml.

Between January 2003 to October 2007, 105 men (<45-year-old) and 285 men (≥45-year-old) were respectively referred from a health promotion center due to an elevated PSA level (≥4.00 ng/ml). Among them, the men with prostatitis-associated symptoms and pyuria (≥5WBC/HPF) on urinalysis, those taking medication that influence the PSA level or those men with a short follow-up period (<6 months) were excluded. The pattern of change of the PSA level in men younger than 45 years (group 1) was analyzed, and the results were compared with those of men whose age was ≥45 years (group 2).

The data from 38 (group 1) and 87 (group 2) men was finally analyzed respectively. In group 1, the median age was 41 (25-44) and the initial PSA level was 5.60ng/ml (4.10-17.00). The PSA levels in 31 men (81.6%) decreased spontaneously during a median follow-up period of 20 months, and the PSA levels in 18 men (47.4%) were spontaneously normalized (<4.00ng/ml), and both of which were significantly higher as compared with those values in group 2 (48.3% and 28.7% respectively). Prostate biopsies were performed in 3 men (group 1), and 33 men (group 2); all of these revealed benign disease.

Despite of an abnormal elevation of PSA, if men are younger than 45 years and they have no specific urologic symptoms, there is little need for immediate exploration for prostatitis or to prescribe antibiotics because the PSA levels decline spontaneously in many cases.