From the Guidelines
For a 69-year-old male, an acceptable PSA rise is generally considered to be less than 0.4 ng/mL per year, as recommended by Bhasin et al. 1. This guideline helps distinguish between normal age-related PSA fluctuations and potentially concerning increases that might warrant further investigation. Some studies suggest that even smaller annual increases, such as 0.35 ng/mL, should prompt additional evaluation for men with very low baseline PSA levels (below 2 ng/mL) 1. Regular PSA monitoring is recommended for men in this age group, typically annually, though the frequency may vary based on baseline values and risk factors. It's essential to understand that PSA levels can be affected by various non-cancerous conditions, including prostatitis, benign prostatic hyperplasia (BPH), recent ejaculation, or prostate manipulation such as cycling or a recent digital rectal exam. Any rapid rise in PSA, regardless of the absolute value, should be discussed with a healthcare provider, as the pattern of increase is often more significant than a single measurement. If concerning PSA changes are detected, further evaluation might include repeat PSA testing, free PSA percentage, prostate MRI, or possibly a prostate biopsy. However, the USPSTF recommends against PSA-based screening for prostate cancer in men aged 70 years and older 1. Given the patient's age (69 years), it is crucial to consider the potential benefits and harms of screening and make an informed decision with their clinician. The American College of Physicians (ACP) 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 1. Ultimately, the decision to undergo periodic PSA-based screening should be an individual one, taking into account the patient's risk factors, general health, and life expectancy.
From the Research
PSA Levels and Age
- For a 69-year-old male, the acceptable rise in PSA levels yearly is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is known that PSA levels can increase with age, and the rate of increase can vary from person to person.
Factors Affecting PSA Levels
- The use of 5-alpha-reductase inhibitors (5-ARIs) can affect PSA levels, with studies showing a reduction in serum PSA levels during treatment with 5-ARIs 3, 5.
- Digital rectal examination (DRE) can also affect PSA levels, with a statistically significant increase in PSA isoforms after DRE 4.
- Other factors such as family history, age, and imaging techniques should also be considered in the clinical and diagnostic follow-up of prostate cancer 5.
PSA Velocity
- PSA velocity, which refers to the rate of change in PSA levels over time, can be an important factor in determining the risk of prostate cancer.
- However, the studies provided do not specifically address the acceptable rise in PSA velocity for a 69-year-old male.
- It is generally recommended that any increase in PSA from nadir should be considered suspicious for malignancy, and other factors such as DRE, age, family history, and imaging techniques should be taken into account 5.