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Prostate Cancer

PSA Changes, is it Time to be Concerned?

03/10/2010

Question:

There is a paternal family history of prostate cancer - father died at 60, p. grandfather died at 72, & uncle prostatectomy. My PSA levels are on the rise...3/06-0.99, 3/07-0.91, 5/08-1.2, 3/09-1.815 & 2/10-2.44. There was a 0.625 change this last time. I`m 53, my G.P. said nothing about the latest change; should I be concerned?

Answer:

The PSA screening is controversial as you probably have read (the American Cancer Society has reportedly recommended discontinuation of PSA screening, but their recommendation is actually more complicated if read in its entirety). PSA screening is still recommended by the American Urologic Society with the understanding that a urologist (or primary care physician) should discuss the risks and benefits of this screening specific to each individual patient. In your case, the screening is valuable because of the familial history of prostate cancer.

Regarding the values that you have provided, PSA is sensitive (meaning that 85% of men with prostate cancer have an elevated PSA) but not specific (meaning that elevated PSA may be caused by many factors including benign enlargement of the prostate, infection of the prostate, and even sexual activity or prostate exam).

Since 15% of men diagnosed with prostate cancer have "normal" PSA, we look at not just the absolute value, but also the "PSA velocity" (change in PSA over time). An increase of greater than 0.45 ng/ml per year is suspicious in men with PSA less than 2.0 ng/ml and a change of greater than 0.75 ng/ml per year is suspicious in men whose PSA is between 2.0 and 4.0 ng/ml. Your increase of 0.625 ng/ml per 11 month interval is borderline.

My suggestion would be to repeat the PSA 6 months after the most recent test and see if annual increase projects > 0.75 ng/ml per year. A urologist should review your results and perform prostate exam. Then discussion regarding risk/benefit of prostate biopsy would be in order. Hope this helps.

For more information:

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati