From the Guidelines
A PSA increase of 0.7 ng/mL in one year for a 66-year-old male is a significant concern and warrants further medical evaluation. According to the most recent and highest quality study 1, the National Comprehensive Cancer Network (NCCN) guidelines recommend considering biopsy for men with a PSA increase of 1.0 ng/mL or more in one year. Although the increase in this case is slightly below this threshold, the velocity of change is still noteworthy and deserves attention.
The patient's baseline PSA level is crucial in determining the significance of this increase. If the PSA level rose from 1.0 to 1.7 ng/mL, this represents a substantial percentage increase that deserves evaluation 1. The patient's doctor may recommend additional testing, such as a free PSA test, PSA density calculation, prostate MRI, or possibly a prostate biopsy, depending on the overall clinical picture.
Several non-cancerous conditions can cause PSA elevation, including prostatitis (inflammation), benign prostatic hyperplasia (BPH), or recent activities like cycling, ejaculation, or urinary tract infections 1. Age-related PSA changes are expected, but the velocity of change (how quickly PSA rises) can be more important than the absolute number. While monitoring this situation, it is essential to continue routine health maintenance and discuss any urinary symptoms with the doctor, as these could provide additional diagnostic context.
It is also important to consider the patient's overall health and risk factors, such as family history, medications, and history of prostate disease and screening 1. The NCCN guidelines recommend a risk and benefit discussion about offering prostate screening for men aged 45-75 years with a PSA level of 1.0 ng/mL or higher. In this case, the patient's age and PSA increase warrant a discussion with the doctor to determine the best course of action.
The patient should schedule an appointment with their urologist to discuss this change and determine the next steps in their care. The doctor will assess the patient's individual risk factors and make recommendations for further testing or monitoring based on the most recent and highest quality evidence 1.
From the Research
PSA Level Increase Concerns
- A PSA level increase of 0.7 in one year for a 66-year-old male may be a concern, as studies have shown that fluctuations in PSA levels can be associated with an increased risk of developing prostate cancer 2.
- According to a retrospective cohort study, a significant increase in prostate cancer risk was observed in men with elevated PSA levels, with an adjusted hazard ratio of 1.82 compared to those with decreased PSA levels 2.
Age and Prostate Cancer Risk
- As men age, their risk of developing prostate cancer and more aggressive forms of the disease increases 3.
- A study found that for each 1-year increase in age, the risk of being diagnosed with a Gleason score ≥3 + 4 cancer increased by 11%, and the risk of being diagnosed with a Gleason score ≥4 + 3 cancer increased by 8.5% 3.
PSA Density and Prostate Cancer Detection
- PSA density, which takes into account the volume of the prostate, can be a useful predictor of clinically significant prostate cancer detection 4, 5.
- A study found that MRI-defined PSA density significantly improved the risk prediction for clinically significant prostate cancer on biopsy, with an area under the curve of 0.77 compared to 0.66 for PSA alone 5.
Screening and Detection
- While PSA-based population screening programs for prostate cancer have been shown to detect more cases of prostate cancer, the evidence for a reduction in prostate cancer mortality is limited 6.
- A systematic review found that none of the systematic reviews or randomized controlled trials found a statistically significant reduction in relative risk of prostate cancer mortality or overall mortality with PSA-based screening 6.