From the FDA Drug Label
In clinical studies, finasteride tablets reduced serum PSA concentration by approximately 50% within six months of treatment. This decrease is predictable over the entire range of PSA values in patients with symptomatic BPH, although it may vary in individuals To interpret an isolated PSA value in patients treated with finasteride tablets for six months or more, PSA values should be doubled for comparison with normal ranges in untreated men.
The FDA drug label does not answer the question.
From the Research
PSA levels in Benign Prostatic Hyperplasia (BPH) can rise moderately, with most men having levels below 10 ng/mL, but can occasionally reach high values, even exceeding 20 ng/mL or reaching 30-40 ng/mL in severe cases with significant prostate enlargement. The relationship between prostate size and PSA is approximately 0.3 ng/mL per 10 grams of prostate tissue 1. Other factors that can temporarily elevate PSA in BPH patients include urinary retention, prostate inflammation, recent ejaculation, prostate manipulation during examination, or urinary tract infections. When evaluating high PSA levels in BPH, physicians typically consider the PSA density (PSA level divided by prostate volume), PSA velocity (rate of change over time), and free-to-total PSA ratio to help distinguish between benign elevations and those potentially indicating prostate cancer. Some studies have shown that a significant proportion of BPH patients can have PSA levels above 4 ng/mL, with 63.4% of BPH subjects having PSA concentrations above this threshold value 2. However, the specificity of the PSA test is not sufficient to discriminate between BPH and prostate cancer at intermediate values, highlighting the need for additional approaches to enhance its specificity for prostate cancer screening without reducing sensitivity.
Some key points to consider in BPH patients with elevated PSA levels include:
- The majority of BPH patients have PSA levels between 4-8 ng/mL, but levels can occasionally exceed 20 ng/mL or reach 30-40 ng/mL in severe cases 1.
- The relationship between prostate size and PSA is approximately 0.3 ng/mL per 10 grams of prostate tissue 1.
- Other factors can temporarily elevate PSA in BPH patients, including urinary retention, prostate inflammation, recent ejaculation, prostate manipulation during examination, or urinary tract infections.
- Physicians consider PSA density, PSA velocity, and free-to-total PSA ratio to help distinguish between benign elevations and those potentially indicating prostate cancer 1, 2.
- The specificity of the PSA test is not sufficient to discriminate between BPH and prostate cancer at intermediate values, highlighting the need for additional approaches to enhance its specificity for prostate cancer screening without reducing sensitivity 2.