PSA screening has led to the earlier diagnosis of prostate cancer in many men. Most urologists feel that this will lead to less prostate cancer mortality in the future.
What is considered to be a normal value of PSA has changed over the years. A PSA of 4 is too high for men that are less than 60. Studies have shown that men with a PSA between 2.5 and 4.0 have a 20-25% chance of having prostate cancer.
Current recommendations by some organizations recommend prostate biopsies for men with a PSA of 2.5 or greater and a 10 year life expectancy. Age adjusted values are
also in use.
PSA Velocity refers to the rise of PSA values from year to year. A rise of 0.75 ng/ml/yr or greater has been considered to be significant. Recent studies have been presented by urologists from Duke (2006 Prostate Cancer Symposium) and Northwestern (2006 American Urologic Association) that conclude PSA velocity for men less than 70 should be lower. As with PSA, lower values that are accepted to be normal will lead to the diagnose of more cancer (more sensitivity), but will lead to more biopsies performed that are negative (less specific).
The following PSA velocities have been recommended:
· Men age < than 60: PSA vel > 0.4 ng/ml/yr is abnormal and should trigger a prostate biopsy
· Men age 60-70: PSA vel > 0.6 ng/ml/yr is abnormal and should trigger a prostate biopsy
· Men >70: PSA vel > 0.75 ng/ml/yr is abnormal and should trigger a prostate biopsy