News & Health Information :: 2008

Preventive Recommendations: Prostate

PSA Levels

A number of studies have shown that a PSA level above 4 ng/mL increases the chance that doctors will find prostate cancer when a biopsy is performed. Several other studies of men with PSA levels in the range of 2.5 to 4.0 ng/mL have shown that a substantial number of men in this group, regardless of age, will be diagnosed with prostate cancer when biopsied.

What are considered acceptable PSA levels change as a man ages. As a result, doctors introduced age-specific PSA reference ranges as a method to increase cancer detection in younger men by lowering the PSA values that trigger biopsy and to decrease unnecessary biopsies in older men by increasing PSA cut-offs. The concern is that by using this lower PSA-level threshold, it is possible that clinically insignificant or unimportant cancers, which would not require treatment, are being unnecessarily diagnosed. Overall, however, about 80 percent of cancers detected by PSA testing alone are biologically significant, meaning they require active treatment.

PSA Velocity

PSA levels commonly fluctuate above and below the normal range, even among healthy men. As a result, doctors prefer to look at the change in PSA values over time - a measurement known as PSA velocity. A number of studies have concluded that tracking the rate of change in PSA levels over time can provide useful information and has increased specificity in detecting prostate cancer when compared to a single PSA measurement. It is designed to better select men for prostate biopsy, the PSA velocity test recommendations include collecting PSA levels over a period of no less than 18 months, using at least three readings to calculate PSA velocity. PSA velocity has been best used in younger men who have elected to begin early detection programs before the age of 50.


Our Prostate Cancer Screening Guidelines

Our doctors recommend the following screening guidelines:

For men in the general population, prostate cancer screening (using both PSA testing and a DRE) should begin at age 50. In high-risk groups, such as men with a family history of prostate cancer, screening (using both PSA testing and DRE) should begin at age 40.

If a man screened with DRE receives an abnormal result, regardless of PSA level, he should be referred to a urologist for further testing.

To balance the influence of age on PSA levels, the following age-specific PSA level cut-offs should be considered:

Greater than or equal to 2.5 ng/mL for men up to age 49
Greater than or equal to 3.5 ng/mL for men aged 50 to 59
Greater than or equal to 4.0 ng/mL for men aged 60 and older.

Men with values outside their age-allowed targets should be considered as candidates for prostate biopsy.

For those men being screened for PSA velocity, a PSA velocity of greater than or equal to 0.75 ng/mL per year should necessitate a prostate biopsy - even if the PSA level is in the normal range.

Again, it is important to remember that the evidence supporting the usefulness of prostate cancer screening is suggestive but not definitive, and to note the potential harms (i.e. anxiety, biopsy complications) that may result from prostate cancer screening. As always, the subject of prostate cancer screening should be discussed with your physician.

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