FROM OUR EXPERTS
Dear Dr. Motola:
What is the normal PSA for a 69 year-old man? At what level does the PSA become troubling or warrant further tests?
PSA cut off levels have been debated for many years. Traditionally the cut off for a normal PSA has been 4, however more recently age-adjusted PSA values are being advocated. Utilizing age-adjusted PSA values helps to explain that the PSA of a 45-year-old should be different than that of a 70-year-old. A PSA less than 3.5 is usually considered normal for men age 55 or younger. Similarly as patients get into their mid 70s, higher values of PSA are now being accepted without the need for the patient to undergo biopsy.
Rather than utilizing the absolute PSA value, the rate of change of the PSA is a very important variable. PSAs that are rising at a very rapid rate are more like to be associated with prostate cancer . A PSA increase of more than 0.75 per year may also be indicative of underlying prostate cancer. Furthermore,...
A 62-year-old patient had surgery to remove his cancerous prostate gland about 6 years ago. Two years after surgery his PSA started to rise and now his PSA is 4.6 ng/ml.
I hate to say it but, it is clear that this patient has failed surgery and has "biochemical failure." In other words, his prostate was removed but there is something in his body making his PSA go up and probably more cancerous cells in his body. Even though he feels fine, this rise in PSA is the only sign that his prostate cancer is trying to return. There are two places were cancer can return: 1) in the pelvis where the prostate used to be located, or 2) elsewhere in the body, suggesting that the cancer has spread. Unfortunately, this is a fairly common problem. Up to 30% of men will not be cured by surgery alone and they will have a rise in their PSA months or years after the prostate is removed. That is why it is crucial for men to have their PSA checked on a regular basis after treatment.
There are f...
Dear Dr. Motola,
If a person has a low PSA can you attribute this to any particular factor or factors? In other words are there any medical reasons for a low PSA? A friend told me that there has to be mitigating factors for this low score.
A low PSA is usually desirable as it will be associated with a lower likelihood of prostate cancer . Prostate cancer is not always associated with an elevated PSA as tumors that are very high grade may be associated with normal PSA . This occurs because high-grade tumors are very dissimilar to normal prostate, and as a result lose their ability to secrete PSA. Most often these patients will have very abnormal digital rectal examination. Patients taking Proscar or Avodart may often have low PSA values. This group of patients needs to have careful scrutiny of the interpretation of their PSA.
You should know
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