From the Guidelines
For a 66-year-old male, a PSA level increase of more than 0.75 ng/mL per year is considered significant and warrants further evaluation, particularly if the total PSA exceeds 4.0 ng/mL. This is based on the most recent and highest quality study available, which emphasizes the importance of PSA velocity (the rate of change) over a single measurement 1. According to this study, men aged 50-70 years with a baseline digital rectal examination (DRE) and PSA < 3 ng/mL, and no other indications for biopsy, should have repeat testing at 1-2 year intervals.
Key Considerations
- PSA levels naturally increase with age due to prostate enlargement, and other factors like prostatitis, urinary tract infections, or recent ejaculation can temporarily elevate PSA 1.
- Regular annual screening is recommended for men aged 50-70 years, especially with risk factors like family history of prostate cancer or African American ethnicity 1.
- The reported median PSA values for men aged 40-49 years range from 0.5-0.7 ng/mL, and the 75th percentile values range from 0.7-0.9 ng/mL, indicating that 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.
Recommendations
- If your PSA increases by more than 0.75 ng/mL in a year, or if you experience a rise of 2.0 ng/mL or more over any period, you should consult your doctor promptly for further assessment, which may include a repeat PSA test, digital rectal examination, or possibly a prostate biopsy 1.
- Remember that PSA is just one screening tool, and changes should be interpreted by your healthcare provider in the context of your overall health 1.
From the Research
PSA Levels in Men Over 50
- The normal PSA level for men over 50 years old is not strictly defined, but studies have derived mean and standard deviation values for different age groups 2.
- For men in the 60 to 69-year group, the upper limit for PSA is approximately 5.4 ng/mL, which is the mean plus 2 standard deviations 2.
Factors Affecting PSA Levels
- Age is a significant factor in PSA levels, with older men tend to have higher PSA levels 3, 2.
- Prostate volume also affects PSA levels, with larger prostates tend to have lower PSA densities 4.
- Finasteride, a medication used to treat benign prostatic hyperplasia, can decrease PSA levels by approximately 50% 5, 6.
PSA Velocity and Prostate Cancer Risk
- A rising PSA level is associated with an increased risk of prostate cancer 3.
- The rate of change of PSA levels, known as PSA velocity, can be used to assess the risk of prostate cancer 3.
- However, the use of finasteride can affect PSA velocity, and its impact on prostate cancer risk assessment is still being studied 4, 6.
Guidelines for PSA Increase
- There is no specific guideline for what constitutes an "ok" increase in PSA for a 66-year-old male.
- However, a study suggests that a PSA increase of less than 0.4 ng/mL per year may be considered a low risk for prostate cancer 3.
- It is essential to consider individual factors, such as prostate volume, family history, and digital rectal examination results, when assessing PSA levels and prostate cancer risk 3, 4.