From the Guidelines
For a 61-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 helps distinguish between normal age-related PSA increases and potentially concerning rises that might warrant further investigation.
- For men with a baseline PSA below 4 ng/mL, even smaller annual increases (0.4 ng/mL or less) are preferable.
- 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 over 50, or earlier for those with risk factors like family history.
- 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.
- Remember that PSA results should always be interpreted by a healthcare provider who can consider your complete medical history and other risk factors. The American College of Physicians (ACP) also 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. Additionally, the American Cancer Society (ACS) recommends that men at average risk receive information about the benefits, risks, and uncertainties associated with prostate cancer screening, starting at age 50, and that men at higher risk, including African American men and men with a family history of prostate cancer, receive this information starting at age 45 1.
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 61-year-old male 2, 3, 4, 5, 6.
- However, it is mentioned that 5-alpha-reductase inhibitors (5-ARIs) reduce serum prostate-specific antigen (PSA) concentrations by 50% 2.
- To account for this reduction, PSA levels for 5-ARI users are often adjusted by doubling the value, consistent with previous clinical trials 2.
Prostate Cancer Risk and 5-ARIs
- The use of 5-ARIs has been associated with a reduced risk of overall prostate cancer, low-grade prostate cancer, and delayed prostate cancer pathologic progression 6.
- However, 5-ARIs may not significantly impact the risk of high-grade prostate cancer, prostate cancer-specific mortality, or all-cause mortality 4, 5, 6.