From the Research
For a 69-year-old male, an acceptable PSA rise is generally considered to be less than 0.75 ng/mL per year, with a PSA velocity ideally remaining below 0.35 ng/mL annually for men with PSA levels under 4 ng/mL. This recommendation is based on the most recent and highest quality study available, which 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 prostate cancer-specific mortality and metastatic prostate cancer 1. Key factors to consider include:
- The absolute PSA value, with levels under 4.0 ng/mL typically considered normal
- Age-specific reference ranges, which may allow slightly higher values for older men
- Non-cancerous conditions that can affect PSA levels, such as benign prostatic hyperplasia (BPH), prostatitis, recent ejaculation, or certain medications
- The importance of regular annual PSA screening to establish a personal baseline and track changes over time It is essential to note that any consistent upward trend in PSA levels deserves medical attention, and consultation with a urologist is recommended for evaluation, which may include digital rectal examination, repeat PSA testing, or possibly imaging studies or biopsy depending on the specific situation. The study by 1 provides the most recent and relevant evidence, suggesting that PSA screening after age 70 years may benefit men at high risk of prostate cancer-specific mortality or metastatic prostate cancer, and that PSA levels from age 65 to 69 years can be highly informative for adverse prostate cancer outcomes after age 70 years. In contrast to older studies, such as 2, 3, 4, and 5, which provide valuable insights into the relationship between PSA levels and prostate cancer risk, the study by 1 offers the most up-to-date and relevant guidance for clinical practice.