New England Journal of Medicine,1996; 335:304-310
The prostate produces PSA for several beneficial purposes, not simply as a response to cancer. This is why your doctor might not consider a PSA of 4 ng/ml to be particularly serious, depending on your age, race, and other factors. And, according to the NCCN, about 25 percent of men who have prostate cancer have a low PSA.
LEVELSNumbers and Assays There is no single set of numbers for PSA. Different assays give different numbers and ranges. For example, Hybritech, the most commonly used assay,has a "normal" range of 0 to 4, while the Yang range is 0 to 2.5. Find out what test you are given, and sure to use the same test every time you have your PSA checked. Changing assays makes it difficult to tell if your PSA is stable.
PSA and Age Because PSA rises with age (and with BPH), a level that would be alarming in a twenty-year-old could be normal for a sixty-year-old.
PSA and Race PSA ranges differ by race. The normal, or safe, range for European-American men from 50 to 80 is 0 to 3.5 ng/ml. The range for African-American men is 0 to 2.0 ng/ml for men in their 40s, rising to 4.0 when they are in their 50s, 4.5 in their 60s, and 5.5 in their 70s.
The principal benefit of the test is that it can eliminate many unnecessary biopsies. The Hybritech Free-PSA test is reported to have detected 95% of prostate cancers. And those that it missed were mostly small and not life-threatening.Journal of the American Medical Association, May 20, 1998
Although it would seem to make sense to use the Free-PSA test instead of the usual one, its results can be misleading. (For example, prostatitis causes a reduction in Free-PSA.) In the end, a steady rise in PSA is still a better indicator of cancer.
Lab error isn't likely, but it is possible. If you have an unusually big rise in PSA, you should retest.
Infections, including prostatitis. If you have a burning feeling when urinating, and your PSA reading seems abnormally elevated, suggest to your doctor that you take antibiotics for a couple of weeks before re-testing. Be sure to stop long enough before the test to avoid having it be affected by the antibiotics (which would cause your PSA to fall).
Ejaculation within the previous 48 hours. (Studies seem to be evenly split on whether or not this has an effect, so abstinence is the safest course.)
Any procedure that may stimulate the prostate, such as a TURP (transurethral resection of the prostate, a surgical treatment of benign prostatic tumors), a biopsy, a digital-rectal exam, or a cystoscopy (an examination of the urethra, prostate, bladder, and/or kidneys that involves a catheter-like instrument).
PSAs are often noted to unexpectedly rise within 12-24 months and then fall back to nadir levels (typically with the aid of medications used to treat prostatitis, such as antibiotics, Ibuprofen, Hytrin, Cardura, or Flomax. Even though there is no precise explanation, reasons postulated include radiation-related tissue changes. The important thing is that patients be aware of this phenomenon and not panic if it occurs.
Proscar (finasteride), which is used to treat BPH, and Propecia, which is the same drug but marketed for hair restoration.
After External Beam Radiation Therapy plus Brachytherapy According to Critz et al., "the definition of disease freedom for radiotherapy should be men who achieve and maintain a PSA nadir of 0.2 ng/mL or less."New England Journal of Medicine, January 2000 Others place it higher.
After Brachytherapy under 1.0, according to Brachytherapy Made Complicated, the textbook by Drs. Wallner, Blasko, and Dattoli (but see one-year bump)
After a Radical Prostatectomy theoretically 0.0, but 0.1 ng/ml is okay. According to Daniel W. Chan, Director of Clinical Chemistry at Johns Hopkins, 0.2 is the point of biological recurrence. DeKalb puts the crucial point at 0.5.
After Cryotherapy The Crittenton website seems to say that less than 0.5 ng/ml is safe. NEMC.org puts it at no higher than 0.3.
These figures may not be accurate for everyone. For example, one brachytherapist has several patients who have had a steady PSA of 2.0 for many years. Technically, they have suffered biochemical failure, yet they are alive and well more than a decade later.
According to Dr. Susan Slovin of Memorial Sloan Kettering Cancer Center, a rising PSA does not always indicate cancer or a recurrence. Moreover, even a steady rise and a very high PSA do not necessarily mean that a man will die of prostate cancer. A recent study suggests that a rising PSA "may indicate that the body is attempting to fight cancer by producing its own antiangiogenic proteins." The authors suggest that it may even be feasible to introduce PSA into the body as part of a treatment for cancer.Journal of the National Cancer Institute 1999;91:1635-1640
One problem, according to pathologist Dr. Chan of Johns Hopkins, is that PSA tests today are ultrasensitive. "From day to day, the results could varyit could be 0.03, or maybe even 0.05." He, too, emphasizes that biochemical recurrence does not indicate an immediate problem, adding "People need to understand that it might take months or even years before there is any clinical physical evidence."Prostate Cancer Update newsletter, Vol. V, No. 1
CONTENTS FINDING ASSESSING DECIDING TREATING LIVING
Credits, Disclaimer, and Site InformationCopyright © by Bill Dyckes 1997, 1998, 1999, 2000