From the Guidelines
For a 66-year-old man, a PSA increase of less than 0.35 ng/mL per year is generally considered normal, as suggested by the most recent and highest quality study 1.
Key Considerations
- The absolute PSA level should ideally remain below 4.0 ng/mL, though this threshold may vary based on individual factors.
- If your PSA rises more rapidly than 0.35 ng/mL annually or shows a consistent upward trend over multiple tests, you should consult your healthcare provider promptly.
- Rapid PSA velocity (the rate of change) can be more concerning than the absolute number itself.
- Age-specific PSA ranges exist because PSA naturally increases with age due to prostate enlargement.
- Regular annual PSA testing is recommended for men over 50, or starting earlier for those with risk factors like family history of prostate cancer.
Important Factors to Consider
- Various factors can temporarily elevate PSA levels, including recent ejaculation, prostate inflammation, urinary tract infections, or even vigorous exercise, so context is important when interpreting results.
- The American Cancer Society guideline for the early detection of prostate cancer: update 2010 1 suggests that a PSA velocity as low as 0.35 ng/mL per year might be useful to differentiate cancer from noncancer.
- It is essential to consult your healthcare provider if you have any concerns about your PSA levels or prostate health, as they can provide personalized guidance and recommendations based on your individual situation.
From the Research
PSA Levels at Age 66
At age 66, the normal point of increase in PSA levels is not explicitly defined in the provided studies. However, the studies suggest the following:
- A PSA level of greater than 4 μg./l. is considered abnormal and may indicate prostate cancer 2, 3.
- The combination of PSA and digital rectal examination (DRE) can improve the detection of prostate cancer 2, 3.
- The sensitivity and specificity of PSA and DRE vary, with PSA having a sensitivity of 75% and specificity of 87% in one study 3.
- The positive predictive value of a suspicious DRE is appreciable in men with low serum PSA, with values ranging from 5% to 30% depending on the PSA level 4.
Factors Affecting PSA Levels
Several factors can affect PSA levels, including:
- Age: PSA levels tend to increase with age 4.
- Prostate volume: Larger prostates can produce more PSA, leading to higher levels 5.
- Benign prostatic hyperplasia (BPH): BPH can cause an increase in PSA levels 5.
- Prostate cancer: Prostate cancer can cause an increase in PSA levels, especially if the cancer is aggressive 2, 3.
Screening and Diagnosis
The studies suggest that:
- PSA screening can detect prostate cancer at an early stage, especially when combined with DRE 2, 3.
- DRE can detect prostate cancer, especially in men with low serum PSA 4.
- Transrectal ultrasonography (TRUS) can be used to guide biopsies and estimate prostate volume 5.
- Free/total PSA ratio can be used as an additional screening test to improve the detection of prostate cancer 6.