From the Guidelines
For a 64-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. and Bhasin et al. 1. This guideline, known as PSA velocity, helps distinguish between normal age-related PSA increases and potentially concerning changes that might warrant further investigation. For men with very low baseline PSA levels (below 2 ng/mL), even smaller annual increases of 0.7-0.9 ng/mL should prompt additional evaluation, such as repeating the PSA measurement in 3-6 months and performing a biopsy if there is any further increase 1. It's essential to understand that PSA levels naturally increase with age as the prostate enlarges, but rapid rises may indicate prostate cancer or other conditions like prostatitis or benign prostatic hyperplasia (BPH). Regular annual PSA testing is recommended for men in this age group to establish baseline values and track changes over time. If your PSA velocity exceeds these thresholds, your doctor may recommend additional testing, such as a prostate biopsy, MRI, or other specialized tests to determine the cause. Some key points to consider include:
- The American Cancer Society recommends that men with a life expectancy of at least 10 years should have an opportunity to make an informed decision about prostate cancer screening with their healthcare provider 1.
- 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, and patient preferences 1.
- The frequency of screening with the PSA test is not clearly established, but increasing the interval between screening tests may reduce harms 1. Remember that PSA is just one screening tool, and results should always be interpreted by your healthcare provider in the context of your overall health history and physical examination findings.
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 For interpretation of serial PSAs in men taking finasteride tablets, a new PSA baseline should be established at least six months after starting treatment and PSA monitored periodically thereafter 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.
The FDA drug label does not answer the question.
From the Research
PSA Levels and 5-Alpha-Reductase Inhibitors
- The studies provided do not directly address the acceptable rise in PSA levels yearly for a 64-year-old male 2, 3, 4.
- However, it is mentioned that 5-alpha-reductase inhibitors (5-ARIs) can reduce serum prostate-specific antigen (PSA) concentrations by 50% 3.
- In one study, PSA levels decreased by a mean of 47% during 5-ARI use 2.
Prostate Cancer Detection and 5-ARIs
- The use of 5-ARIs has been associated with delayed diagnosis and worse cancer-specific outcomes in men with prostate cancer 3.
- However, another study found that 5-ARI therapy did not adversely affect prostate cancer detection after transrectal ultrasound/magnetic resonance imaging fusion biopsy 4.
PSA Velocity
- None of the provided studies directly discuss the acceptable yearly rise in PSA levels for a 64-year-old male.
- PSA velocity, which refers to the rate of change in PSA levels over time, is an important factor in prostate cancer detection and monitoring 3.
- However, the studies provided do not offer specific guidance on what constitutes an acceptable rise in PSA levels yearly for a 64-year-old male 2, 3, 4.