From the Guidelines
For a 70-year-old male, an acceptable PSA rise is generally less than 0.4 ng/mL per year, as recommended by the most recent guidelines 1. This guideline, known as PSA velocity, helps distinguish between normal age-related PSA fluctuations and potentially concerning increases that might warrant further investigation. The threshold is somewhat higher than for younger men because PSA naturally increases with age due to prostate enlargement. If your PSA rises more than 0.4 ng/mL in a year, your doctor may recommend additional testing such as a prostate biopsy, MRI, or more frequent PSA monitoring. However, interpretation should always consider your baseline PSA level, as men with higher baseline values may experience larger absolute changes while remaining within normal parameters. Other factors affecting PSA include prostate infections, recent ejaculation, certain medications, and prostate manipulation. Regular annual PSA testing is typically recommended for men in their 70s who are in good health with a life expectancy of at least 10 years, though this should be discussed with your healthcare provider based on your overall health status and medical history. Some studies suggest that men over 70 years old may not benefit from routine PSA screening, and the decision to screen should be individualized based on the patient's health status and preferences 1. It's essential to weigh the potential benefits and harms of PSA screening and discuss the risks and benefits with your healthcare provider. In general, the benefits of PSA screening are more significant for men with a higher risk of prostate cancer, such as those with a family history or African American men. On the other hand, the harms of PSA screening, including overdiagnosis and overtreatment, are more significant for men with a lower risk of prostate cancer. Therefore, a PSA rise of less than 0.4 ng/mL per year is considered acceptable for a 70-year-old male, but the decision to screen and the interpretation of PSA results should be individualized based on the patient's health status and preferences.
From the Research
PSA Levels in Men Aged 70 Years and Over
- The study 2 found that 11% of men aged 70 years and over had a PSA level of ≥6.5 ng/mL, increasing from 7.5% of men aged 70-74 years to 31.4% of men aged ≥90 years.
- The same study 2 reported that PSA levels varied with ethnicity, with Australian-born men having the highest levels (median, 2.3 ng/mL; 5th-95th percentile, 0.4-10.1 ng/mL).
- Another study 3 found that higher baseline PSA level between age 65 and 69 years was associated with 10-year prostate cancer-specific mortality (PCSM) risk.
Acceptable Rise in PSA Yearly
- There is no specific study that provides a clear answer to what is an acceptable rise in PSA yearly for a 70-year-old male.
- However, the study 3 suggests that PSA values from age 65 to 69 years may be highly informative for adverse prostate cancer outcomes after age 70 years, with a PSA less than 1 ng/mL associated with a very low risk of long-term PCSM and metastatic prostate cancer (mPCa).
- The study 4 found that performing a digital rectal examination (DRE) immediately before PSA measurement might change the clinical decision-making on a significant number of occasions, with a mean increase of 0.47 ng/mL in PSA levels after DRE.
Digital Rectal Examination and PSA Measurement
- The study 5 found that the positive predictive value of a suspicious digital rectal examination was 5,14, and 30% in men with PSA 0 to 1.0,1.1 to 2.5, and 2.6 to 4.0 ng/mL, respectively.
- Another study 6 found that finasteride improves the sensitivity of digital rectal examination for prostate cancer detection, with a significant increase in sensitivity for detecting higher grade tumors.