What is a good range of Prostate-Specific Antigen (PSA) increase for a 66-year-old male?

From the Guidelines

For a 66-year-old male, a PSA increase of more than 0.4 ng per milliliter per year is considered concerning and warrants further evaluation, as recommended by the most recent and highest quality study 1. When evaluating PSA levels, it's essential to consider the rate of change, known as PSA velocity, as well as the absolute PSA value.

• A PSA level below 4.0 ng/mL is generally considered normal, but annual increases of less than 0.75 ng/mL per year are recommended to minimize the risk of prostate cancer 1.
• However, the American Cancer Society guideline for the early detection of prostate cancer: update 2010, suggests that PSA velocity may not be as useful as previously thought in predicting prostate cancer risk, and instead recommends individualized risk assessment for men with PSA levels between 2.5 ng/mL and 4.0 ng/mL 1.
• It's also important to note that PSA levels can be affected by various non-cancerous conditions, such as prostatitis, benign prostatic hyperplasia (BPH), recent ejaculation, or certain medications like finasteride or dutasteride, which can artificially lower PSA readings by approximately 50% 1.
• Regular PSA monitoring is recommended for men in this age group, typically once per year, though individual risk factors may necessitate more frequent testing.
• If a significant PSA increase is noticed, it's crucial to consult a healthcare provider promptly for proper evaluation, which may include digital rectal examination, repeat PSA testing, or referral to a urologist for possible prostate biopsy, depending on the specific situation and risk factors 1.

From the FDA Drug Label

1. 1 Effects on Prostate Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection In clinical studies, finasteride tablets reduced serum PSA concentration by approximately 50% within six months of treatment. This decrease is predictable over the entire range of PSA values in patients with symptomatic BPH, although it may vary in individuals For interpretation of serial PSAs in men taking finasteride tablets, a new PSA baseline should be established at least six months after starting treatment and PSA monitored periodically thereafter Any confirmed increase from the lowest PSA value while on finasteride tablets may signal the presence of prostate cancer and should be evaluated, even if PSA levels are still within the normal range for men not taking a 5α-reductase inhibitor.

A good range of PSA increase for a 66-year-old male taking finasteride is not explicitly defined in the drug label. However, any confirmed increase from the lowest PSA value while on finasteride tablets may signal the presence of prostate cancer and should be evaluated. To interpret an isolated PSA value, PSA values should be doubled for comparison with normal ranges in untreated men 2.

From the Research

PSA Increase Range for a 66-Year-Old Male

• The ideal range of PSA increase for a 66-year-old male is not explicitly stated in the provided studies, but we can look at the general guidelines and findings related to PSA levels and their changes over time.
• A study from 1993 3 found that the upper limits for PSA (mean+2 standard deviations) by age were 5.4 ng/ml in the 60 to 69-year group.
• Another study from 2012 4 examined the effect of 5α-reductase inhibitor therapy on prostate cancer detection and found that a change in nadir prostate specific antigen of more than 0.4 ng/ml was used as a trigger for biopsy.
• It's worth noting that the rate of PSA increase, also known as PSA velocity, is also an important factor in evaluating the risk of prostate cancer. A PSA velocity of 0.75 ng/ml or higher was used as a criterion for inclusion in the 2012 study 4.
• However, the exact range of PSA increase that is considered "good" or "safe" for a 66-year-old male is not clearly defined in the provided studies, and more research would be needed to determine this.

Factors Affecting PSA Levels

• Age: PSA levels tend to increase with age, as shown in the 1993 study 3.
• 5α-reductase inhibitor therapy: This type of therapy can decrease PSA levels, as shown in the 2012 study 4 and the 2008 study 5.
• Digital rectal exam (DRE): A DRE can cause a temporary increase in PSA levels, as shown in the 2018 study 6.
• Prostate cancer: An increase in PSA levels can be a sign of prostate cancer, but it can also be caused by other factors such as benign prostatic hyperplasia (BPH) or prostatitis.

PSA Velocity and Prostate Cancer Risk

• A high PSA velocity has been associated with an increased risk of prostate cancer, as shown in the 2012 study 4.
• However, the 2008 study 5 found that 5α-reductase inhibitor therapy was associated with a reduced risk of prostate cancer, but may also increase the risk of high-grade disease in men who are undergoing regular screening for prostate cancer.
• The 2022 study 7 found that 5-ARI use was not associated with an increased risk of prostate cancer mortality among men with regular access to screening and health care.