From the Guidelines
For a 70-year-old male, an acceptable PSA rise is generally considered to be less than 0.75 ng/mL per year. This guideline, known as PSA velocity, helps distinguish between normal age-related PSA fluctuations and potentially concerning increases that might warrant further investigation. However, the absolute PSA level is also important - for men without prostate cancer, total PSA should ideally remain below 4.0 ng/mL, though this threshold may be adjusted based on individual risk factors. If your PSA rises more rapidly than 0.75 ng/mL annually or exceeds the 4.0 ng/mL threshold, your doctor may recommend additional testing such as a prostate biopsy, MRI, or newer biomarker tests like the 4Kscore or SelectMDx. These increases can occur due to benign conditions like prostate enlargement (BPH) or inflammation, but could also indicate prostate cancer. Regular annual PSA screening is generally 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 personal preferences 1.
Some key points to consider:
- The American College of Physicians recommends that clinicians inform men between the age of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer 1.
- The American Urological Association recommends that men over age 70 years who are in excellent health may benefit from prostate cancer screening, but evidence to support the magnitude of benefit in this age group is extremely limited 1.
- The National Comprehensive Cancer Network recommends that testing above the age of 70 years of age should be done with caution and only in very healthy men with little or no comorbidity 1.
- Men who have a PSA above the median for their age group are at a higher risk for prostate cancer and for the aggressive form of the disease 1.
It's essential to weigh the potential benefits and harms of PSA screening and discuss individual risk factors and preferences with a healthcare provider to make an informed decision about screening.
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 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.
Digital Rectal Examination and PSA Measurement
- The study 5 found that finasteride improves the sensitivity of digital rectal examination for prostate cancer detection.
- The study 4 found that the sensitivity of digital rectal examination was greater for detecting higher grade tumors, and that the positive predictive value of digital rectal examination was appreciable in men with low serum PSA.
- The study 6 found that dutasteride, alone or in combination with tamsulosin, significantly reduced the relative risk of prostate cancer diagnosis in men with benign prostatic hyperplasia undergoing annual digital rectal examination and PSA screening.