The aim of this study was to study the incidence and possibility of prostate cancer detection in patients <50 years with prostate-specific antigen (PSA) <4 ng ml(-1). Between January 2006 and January 2008, 355 men were subjected to radical cystoprostatectomy for bladder cancer. Among 162 cases without pathological prostatic invasion, random selection of two groups with serum PSA <4 ng ml(-1) was carried out. According to the age, 56 pairs in group A (< or =50 years) and group B (>50 years) were selected randomly. The resected prostate glands of each group were examined pathologically for evidence of prostatic adenocarcinoma. Correlation of the age groups with pathological findings, PSA, digital rectal examination (DRE) and body mass index (BMI) was carried out. The mean age of the groups (A and B) was 46.17+/-4.3 and 58.42+/-4.4 years, respectively. Mean PSA was 1.9+/-1.6 ng ml(-1) in group A and 2+/-1.6 ng ml(-1) in group B. Prostatic adenocarcinoma was detected in 1.8 and 10.7% in groups A and B, respectively (P=0.051). High-grade prostatic intraepithelial neoplasia (PIN) was higher in group A than in group B, 11 cases versus 4 (P=0.079). DRE was not significantly associated with pathological findings in those groups of patients. BMI was directly correlated with PSA in patients of group A (mean: 27.8+/-4.4, CC: 0.5, P=0.015), but not with that of group B (mean: 27.5+/-4.8, CC: 0.16, P=0.239). A new PSA cut-off point for younger patients (<50 years) is warranted. Serum PSA 2 ng ml(-1) is recommended as a cut-off point to screen and biopsy advice for nonsymptomatic patients <50 years. High-grade PIN was higher among the younger patients with low serum PSA, which indeed needs a meticulous follow-up.