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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,...
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.
At What Age Should I Start Getting PSA Tests? The age at which one should first have a prostate cancer screening has been debated. The recommendations of the American Cancer Society are for all patients over the age of 50 to undergo digital rectal examination and PSA testing . However, few weeks go by in the office without a patient under the age of 30 who requests a prostate cancer screening. Using 50 as an arbitrary age cut-off is subject to much discussion. Patients who are at high risk for prostate cancer – such as African-American men or those with a strong family history of a father or brother who were diagnosed with prostate cancer prior to age 65 – should begin screening at age 45. Prostate cancer is the second leading cause of cancer death in African-American males. African-American males have a 60% higher incidence of prostate cancer as well as a higher death rate from prostate cancer than white males – 64% vs. 26.2% according t...
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