Prostate-specific antigen (PSA) is something made by the prostate gland. High PSA levels may be a sign of prostate cancer, a noncancerous condition such as prostatitis, or an enlarged prostate gland.
PSA levels under 4 ng/ml are generally considered normal, while levels over 4 ng/ml are considered abnormal. PSA levels between 4 and 10 ng/ml indicate a risk of prostate cancer higher than normal. When the PSA level is above 10 ng/ml, risk of prostate cancer is much higher.
3.5-4.5: Normal for a man 60-70 yrs. 4.5-5.5: Normal for a man 70-80 yrs.
For men aged 70 to 79, they suggested a normal serum PSA reference range of 0.0–6.5 ng/mL (0.0–6.5 μg/L). In our population, 38% of patients with clinically significant and 37% with high-grade prostate cancer had a serum PSA level lower than 6.5 μg/L and would have been missed using age-specific guidelines.
Decoding a PSA Test
In general: For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml. For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal.
A prostate-specific antigen (PSA) level above 4 ng/mL has historically been recognized as an appropriate threshold to recommend biopsy; however the risk of high-grade disease observed among men with lower PSA levels in the Prostate Cancer Prevention Trial has led to calls to change the criteria for biopsy referral.
The median serum PSA level (5th to 95th percentile) for the entire cohort was 1.9 ng/mL (0.3–8.9 ng/mL). The median PSA levels (5th to 95th percentile) rose from 1.6 ng/mL (0.4–7.5 ng/mL) in men aged 70–74 years up to 2.8 ng/mL (0.1–18.0 ng/mL) in men aged 90 years and over (Box 2).
You will feel some pressure when the probe is inserted, but it is usually not painful. Usually between 6 – 12 (sometimes more) prostatic tissue samples are obtained and the entire procedure lasts about 10 minutes. A local anesthetic can be used to numb the area and reduce any pain.
They found that men with PSA levels of 2 ng/ml or higher at age 60 were 26 times more likely to die from prostate cancer over the next 25 years than men with scores below 1 ng/ml.
A patient may take about four to six weeks or even more recover after a prostate biopsy. The recovery process after biopsy usually depends on the patient's health and age. Doctors may recommend only light activities for 24-48 hours after a prostate biopsy.
PSA levels can be confusing. They can go up and down for no obvious reason. They can rise after treatment. And levels tend to be higher in older men and those with large prostates.
Prostate biopsies in elderly men are justified only among those aged 76-79 with PSA levels below 20 and minor comorbidities, “as this is the group of patients who could benefit from radical treatment.”
Regarding the results of the present study, the normal PSA level increased by age from 2.5th percentile to 95th percentile. As a result, the normal PSA level increased from 0.00 ng/mL to 4.89 ng/mL in the age group of 60–64 years and 0.0 ng/mL to 33.17 ng/mL in the age group of 85 years and over.
As a PSA level > 2000 ng/mL strongly suggests prostate cancer, we started ADT before obtaining a histological diagnosis.
The procedure may be done under a local or general anesthetic. (Local anesthetic means medicines are used to make you numb. General anesthetic means medicines are used to put you into a deep sleep during the procedure.)
Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed.
If you feel faint or unwell after leaving the biopsy room, please tell the nurse. We would recommend that you have someone to drive you home, but if you are driving yourself home then you must make sure that you are feeling well. We recommend that you have a drink and something to eat before you leave the hospital.
In men at average risk, the harms of PSA testing often outweigh the benefits. American Urological Association (AUA) age guidelines: The AUA does not recommend routine PSA screening for men 70 or older or with a life expectancy of less than 10 to 15 years.
In addition to prostate cancer, several benign (not cancerous) conditions can cause a person's PSA level to rise, particularly prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate).
Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3. Most men without prostate cancer have PSA levels under 4 ng/mL of blood.
Alcohol and caffeinated drinks are not established risk factors for prostate cancer and will not affect PSA levels.
Prostate enlargement happens to almost all men as they get older. An enlarged prostate is often called benign prostatic hyperplasia (BPH). It is not cancer, and it does not raise your risk for prostate cancer.
While most prostate biopsies are performed through the rectum (transrectal), there is a means to obtain prostate tissue samples through the perineum using an external entry point at the skin. The technique, known as transperineal biopsy, is now offered to men who are good candidates for this approach.