From the Guidelines
A rise in PSA from 1.9 to 2.97 warrants attention but not immediate alarm, and you should discuss this change with your doctor to determine the best course of action. The absolute value of 2.97 is still within the traditional normal range (typically under 4.0 ng/mL) 1. However, the rate of increase (over 50%) could be significant depending on the timeframe between tests. PSA (Prostate Specific Antigen) levels can fluctuate due to many factors besides prostate cancer, including benign prostate enlargement, inflammation, recent ejaculation, vigorous exercise, or certain medications.
Key Considerations
- Your doctor might consider your PSA velocity (how quickly the level rises), your age, family history, and other risk factors when determining next steps 1.
- If concerned, your doctor might recommend additional tests such as a free PSA test, prostate MRI, or possibly a biopsy.
- Regular monitoring is important as PSA trends over time provide more valuable information than a single measurement.
Next Steps
- Discuss the change in PSA level with your doctor to determine if further testing or monitoring is needed.
- Consider factors that may have influenced the PSA level, such as recent medical procedures or medications.
- Follow your doctor's recommendations for additional testing or monitoring to ensure prompt detection and treatment of any potential issues.
From the FDA Drug Label
In clinical studies, finasteride tablets reduced serum PSA concentration by approximately 50% within six months of treatment. Any confirmed increase from the lowest PSA value while on finasteride tablets may signal the presence of prostate cancer and should be evaluated, even if PSA levels are still within the normal range for men not taking a 5α-reductase inhibitor. 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.
Your PSA increased from 1.9 to 2.97. This increase should be evaluated by your doctor, as it may signal the presence of prostate cancer, even if the PSA level is still within the normal range for men not taking finasteride.
- It is essential to establish a new PSA baseline at least six months after starting finasteride treatment and monitor PSA levels periodically thereafter.
- If you are taking finasteride, your doctor may need to double your PSA value for comparison with normal ranges in untreated men to accurately interpret the results 2.
From the Research
Prostate-Specific Antigen (PSA) Levels
- A PSA level increase from 1.9 to 2.97 may be a cause for concern, but it is essential to consider this value in the context of other diagnostic tools and factors 3, 4.
- The sensitivity and specificity of PSA levels in detecting prostate cancer vary, with studies indicating that a PSA level <4 ng/ml can be associated with a higher sensitivity and specificity for detecting clinically significant prostate cancer 3.
Digital Rectal Examination (DRE) and PSA
- DRE is a valuable tool in the diagnosis of prostate cancer, particularly when used in conjunction with PSA testing 4, 5.
- The combination of PSA and DRE can improve the stage of diagnosis of patients with prostate cancer, with studies indicating that this combination can detect prostate cancer more effectively than either test alone 6.
Interpretation of PSA Levels
- A PSA level of 2.97 is considered relatively low, but it is crucial to monitor changes in PSA levels over time to assess the risk of prostate cancer 4, 6.
- The rate of change of PSA levels, rather than a single value, may be a more significant indicator of prostate cancer risk 7.