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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.
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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,...
Alternative Names Prostate-specific antigen; Prostatecancer screening test Normal Values No certain PSA level that is called normal or abnormal. No PSA level means you do or do not have prostate cancer. Remember that the PSA test cannot diagnose cancer. Only a biopsy can diagnose cancer. Always discuss PSA test results with your doctor Your doctor will look at your PSA results and must consider your age, your race, medicines you are taking, and a number of other factors to decide whether your PSA is normal and whether you need more tests done. Older men typically have slightly higher PSA levels than younger men. Normal ranges by age group commonly used include: Men below age 50: PSA less than 2.5 Men 50 - 59 years: PSA level less than 3.5 Men 60 - 69 years: PSA level less than 4.5 Men older than 70 years: PSA level less than 6.5 Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. What abnormal results mean A high...
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