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 series of studies were recently published in the New England Journal of Medicine that question the efficacy of widespread PSA testing for the early detection of prostate cancer. One study, The European Randomized Study of Screening for Prostate Cancer (ERSPC Trial), involved 182,000 men in Europe. An American study from the Prostate, Lung Colorectal, and Ovarian (PLCO) Cancer Screening Trial looked at nearly 77,000 men in 10 medical centers.
For the last 20 years, urologists have been practicing in an era that advocates the early detection of prostate cancer . This has led to a decrease in the death rate from prostate cancer. With the decrease in death rates that we have been experiencing, we have to somehow explain what we as physicians are doing that is contributing to this. These studies may suggest that PSA screening may not be responsible for this.
However, several major flaws have been identified with these studies.
1. Most importantly, in the PLCO study, the PSA lev...
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,...
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