Is My PSA Level Normal? The absolute value of PSA has been the long-term standard of care to determine whether one’s PSA elevation is significant. Previously, the magic number of “4” was defined as being the upper limit of “normal.” However, this may not be a good rule of thumb since approximately 15% of prostate cancers can occur in men with a “normal” PSA. When interpreting a PSA value, several factors need to be taken into consideration—not just the absolute value of the PSA. Some of these factors include: Age adjustment of the PSA PSA density Percent free PSA PSA velocity Age-Adjusted PSA Recent data has redefined the way that urologists look at PSA, and what is considered a "normal" PSA. Age-adjusted PSA values take into account that a 40-year-old should not have the same PSA as an 80-year-old. Accepted age-adjusted PSA rates are below 2.4 ng/ml for men under...
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.
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