What is an acceptable yearly rise in Prostate-Specific Antigen (PSA) for a 66-year-old male?

From the Guidelines

For a 66-year-old male, an acceptable PSA rise is generally considered to be less than 1.0 ng/mL per year, as recommended by Morgentaler et al. 1 and Bhasin et al. 1. This guideline helps distinguish between normal age-related PSA fluctuations and potentially concerning increases that might warrant further investigation. Most physicians become concerned when PSA increases by more than 1.0 ng/mL annually, especially if the baseline PSA is already elevated above 4.0 ng/mL. However, interpretation should always consider the individual's baseline PSA level, as men with lower starting values (below 4.0 ng/mL) might have smaller acceptable increases. It's essential to understand that PSA levels naturally rise with age due to prostate enlargement, and factors like prostatitis, recent ejaculation, or certain medications can temporarily elevate PSA. Regular annual PSA testing is recommended for men over 50 (or earlier for those with risk factors) to establish a personal baseline and track changes over time. If your PSA rise exceeds these guidelines, your doctor may recommend additional testing such as a free PSA test, prostate MRI, or possibly a biopsy to rule out prostate cancer. Some studies suggest that the frequency of screening with the PSA test should be based on individual risk factors and life expectancy, with no clear evidence to guide decisions about the periodicity or frequency of evaluation 1. In general, the American College of Physicians recommends that clinicians inform men between the ages of 50 and 69 about the limited potential benefits and substantial harms of screening for prostate cancer, and base the decision to screen on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1. Ultimately, the decision to screen for prostate cancer should be made on an individual basis, taking into account the patient's unique risk factors, health status, and personal preferences.

From the Research

Acceptable Rise in PSA Yearly for a 66-year-old Male

• There is no specific evidence in the provided studies that directly addresses the acceptable rise in PSA levels yearly for a 66-year-old male 2, 3, 4, 5.
• However, the studies discuss the effects of 5-alpha reductase inhibitors (5-ARIs) on PSA levels and prostate cancer detection.
• According to the study published in JAMA internal medicine, 5-ARIs reduce serum prostate-specific antigen (PSA) concentrations by 50% 3.
• Another study published in Cancer epidemiology, biomarkers & prevention found that men using 5-ARIs underwent more PSA testing, prostate exams, and biopsies, but 5-ARI use was not associated with developing lethal disease or cancer-specific death after diagnosis 4.
• The study in Scientific reports found that 5-ARI therapy did not adversely affect prostate cancer detection after transrectal ultrasound/magnetic resonance imaging fusion biopsy 5.
• The study published in BJU international found that during 5-ARI use, PSA levels decreased by a mean of 47% 2.

Key Findings

• 5-ARIs reduce PSA levels, which may affect prostate cancer detection 2, 3.
• Regular health care access and screening may mitigate the potential risks associated with 5-ARI use 4.
• The performance of multi-parametric magnetic resonance imaging (mpMRI) in predicting prostate cancer is not significantly affected by 5-ARI use 5.