From the Guidelines
A PSA level of 2.35 ng/mL is considered within the normal range, and no immediate action is required based solely on this value. According to the NCCN clinical practice guidelines for prostate cancer early detection, version 2.2015 1, PSA levels below 4.0 ng/mL are generally considered normal. However, it's essential to interpret this value in context with your age, medical history, and previous PSA measurements. If this represents an increase from previous tests, even within the normal range, it may warrant discussion with your healthcare provider.
- Key points to consider:
- PSA levels can be influenced by non-cancerous conditions like prostatitis, benign prostatic hyperplasia (BPH), or recent ejaculation 1.
- Regular PSA screening is recommended for men aged 55-69, with the frequency determined by your doctor based on your risk factors.
- If you're experiencing urinary symptoms or have a family history of prostate cancer, inform your doctor during your next visit.
- PSA testing is just one tool for prostate health assessment and should be part of a comprehensive evaluation. It's also important to note that PSA is not a cancer-specific marker, and most men with elevated PSA levels do not have prostate cancer, as only about 25% of men with PSA in the 4 to 10 ng/mL range have a subsequent positive biopsy 1.
From the FDA Drug Label
5. 1 Effects on Prostate-Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection In clinical trials, dutasteride reduced serum PSA concentration by approximately 50% within 3 to 6 months of treatment. To interpret an isolated PSA value in a man treated with dutasteride for 3 months or more, the PSA value should be doubled for comparison with normal values in untreated men.
Given a PSA Total of 2.35, to interpret this value in a man treated with dutasteride for 3 months or more, the PSA value should be doubled for comparison with normal values in untreated men. Therefore, the adjusted PSA value would be 4.70.
From the Research
PSA Total 2.35
- The patient's PSA total is 2.35, which is below the typical threshold for concern [(2, 3)].
- Studies have shown that 5-alpha-reductase inhibitors (5ARIs) can reduce serum PSA levels over time, with a reduction observable up to 48 months after starting therapy 2.
- The reduction in PSA levels during 5ARI treatment can improve the diagnostic performance of PSA in screening for prostate cancer, but may also reduce the diagnosis of indolent cancers 2.
Diagnostic Considerations
- Any increase in PSA from nadir should be considered suspicious for malignancy, but other factors such as digital rectal examination, age, family history of prostate cancer, and imaging techniques should also be considered in clinical and diagnostic follow-up 2.
- The percentage of prostate-specific antigen (PSA) isoform [-2]proPSA and the Prostate Health Index (PHI) have been shown to improve diagnostic accuracy for clinically relevant prostate cancer at initial and repeat biopsy compared to total PSA and percentage free PSA in men aged ≤65 years [(4, 5)].
- Digital rectal examination can be an effective tool for detecting prostate cancer, particularly in men with low serum PSA levels 6.