From the Guidelines
A concerning jump in PSA levels is generally considered to be a rise of 0.75 ng/mL or more in one year, or a PSA velocity greater than 0.35 ng/mL per year, as recommended by recent guidelines 1. When interpreting PSA changes, it's essential to consider the context, including the patient's baseline PSA level, age, and medical history. For men with a baseline PSA under 4 ng/mL, these thresholds are particularly significant. However, for men who have had prostate cancer treatment, different standards may apply, such as any detectable PSA above 0.2 ng/mL after radical prostatectomy or a rise of 2 ng/mL above the nadir after radiation therapy. Some key points to consider when evaluating PSA levels include:
- PSA velocity, which is the rate of change of PSA levels over time, is often more meaningful than a single measurement 1.
- Age-specific PSA levels, which can help identify abnormal changes in PSA levels for men of different ages 1.
- The importance of confirming any elevated PSA reading with repeat testing before making clinical decisions, as PSA levels can fluctuate due to non-cancerous conditions like prostatitis or benign prostatic hyperplasia 1.
- The use of extended or saturation biopsy schemes, which can help identify more cancer at initial biopsy and decrease the false negative rate 1. It's also important to note that individualized risk assessment, taking into account multiple factors such as free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history, and comorbidities, may be a more appropriate way to characterize the risk of prostate cancer 1.
From the FDA Drug Label
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.
A concerning jump in PSA levels is any confirmed increase from the lowest PSA value while on finasteride tablets, which may signal the presence of prostate cancer and should be evaluated. 2
From the Research
Concerning Jump in PSA Levels
A concerning jump in PSA levels is often evaluated based on the rate of change, known as PSA velocity. According to the study 3, a PSA velocity higher than 0.75 ng/mL per year is considered abnormal and may indicate the need for further testing, including prostate biopsy.
Factors Influencing PSA Levels
Several factors can influence PSA levels, including age, race, and digital rectal examination findings. The study 4 found that the positive predictive value of a suspicious digital rectal examination was appreciable in men with low serum PSA levels.
Repeat PSA Testing
Repeat PSA testing can provide valuable information for risk stratification and decision-making. The study 5 found that men who had a decrease in PSA level on repeat testing had a significantly lower risk of clinically significant prostate cancer, while those with an increased PSA level had a higher risk.
Key Findings
- A PSA velocity higher than 0.75 ng/mL per year is considered abnormal 3
- Repeat PSA testing can improve risk stratification and decision-making 5
- Digital rectal examination findings can provide additional information for detecting clinically significant prostate cancer 4, 6, and 7
- A concerning jump in PSA levels should be evaluated in the context of individual patient factors and medical history
Considerations for Prostate Biopsy
Prostate biopsy may be recommended based on PSA levels, digital rectal examination findings, and other factors. The study 3 found that a high proportion of men with an abnormal PSA finding had a normal PSA finding at subsequent visits, highlighting the importance of confirming abnormal results before proceeding with further testing.