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Posted: Sat Jul 15, 2006 9:21 pm
by webslave
This question is frequently asked. Raised PSA scores cause a lot of concern.

I received this email from a friend (I do not usually answer medical emails): wrote:Why does PSA rise in CP/CPPS patients in the absence of infection? My GP was concerned with my PSA (4-pt.-something) and wanted me to see a urologist!
I replied:
webslave wrote: Inflammation alone can raise PSA. In general, it can be elevated due to BPH, prostatitis, prostatic infarct, and likely some other reasons. It can also vary by chance alone, and of course there could have been a lab error. A recheck after a month or so is wise.

PSA is not specific for prostate cancer, but if you have an asymptomatic PSA elevation, look out. It is unwise to say, "Hey it's probably just inflammation...forget about it"... It probably isn't prostate cancer, but IMHO this should be checked out.

Men with CPPS have very different PSA scores. Some have huge boggy prostates with PSA's >10 and no symptoms and others have horrible symptoms with tiny prostates and PSA's <1.0.

You can have prostate cancer with a PSA under 4 and have benign disease with a PSA in the 20's.

There are cancers which do NOT raise PSA.

Other tests: "total free PSA ratio" test has no value. Elevations from prostate cancer and prostatitis give similarly low values. Only BPH is associated with a high value for Free:total PSA.

Although some labs use 4.0 as the normal cutoff for PSA, many urologists now use an age stratified scale as follows:

Age 40-49 0-2.5 normal
Age 50-59 0-3.5 normal
Age 60-69 0-4.5 normal
Age 70-79 0-6.5 normal

So, if you have a raised PSA score it *is* worth seeing a uro to have the prostate examined digitally, and possibly by ultrasound, and then by biopsy if indicated.

Re: PSA and CPPS

Posted: Sun Jan 06, 2008 8:34 am
by webslave
We must revise the normal range above, because biopsy-detected prostate cancer, including high-grade cancer, is not rare among men with PSA levels of 4.0 ng per milliliter or less — levels generally thought to be in the normal range.
Our finding that as many as 15 percent of men with a “normal” PSA level had prostate cancer underscores the need to consider fundamental changes in the approach to diagnosing prostate cancer. The dilemma of overtreating the clinically unimportant disease that will be detected if the PSA threshold for biopsy is lowered or undertreating potentially clinically important disease that will go undetected if biopsy is not performed in men with a PSA level of 4.0 ng per milliliter or less must be resolved.
Apparently a lot of labs have now (2007) lowered the normal PSA levels.

I obtained this information from someone who reports that he'd run a 2.5 PSA for 3 years, and only a free PSA test detected his prostate cancer.

Re: PSA and CPPS

Posted: Wed Jan 09, 2008 4:16 am
by webslave
Latest PSA figures
From LabCorp, October, 2007 (changed as from April, 2007)

PSA Mean Scores
Ref: JAMA, 289;2695-2700, 2003
Age (Years)PSA ng/mlMean (95%CI)
< 500.8(0.7 - 1.0)
50-591.5(1.3 - 1.7)
60-692.3(2.0 - 2.5)
70-792.8(2.4 - 3.2)
>804.0(0 - 10.2)
Risks of cancer
Ref: NEJM 350;2239-2246, 2004
PSA Level% w/Prostate CancerSensitivitySpecificity
<= 0.56.6%1.00.0
0.6 - 1.010.1%.93.02
1.1 - 2.017.0%.75.33
2.1 - 3.023.9%.37.73
3.1 - 4.026.9%.12.92
Source: LabCorp Dynacare

Re: PSA and CPPS

Posted: Wed May 28, 2008 12:03 pm
by webslave
This suggests that a single PSA test has some predictive value for a long time into the future.
AUA 2008 - A Single PSA Predicts Prostate Cancer up to 30 Years Subsequently, Even in Men Below Age 40

Written by Alexander Kutikov, MD
Monday, 19 May 2008

ORLANDO, FL ( - Would Nostradamus know your PSA? Maybe. Lilja and colleagues demonstrate the prophetic power of the blood test to predict prostate cancer risk even 25 years into the future. The authors report data from a very large cohort of Swedish men (n=21,277) who gave a blood samples between 1974 and 1986 at age 50 or less for a cardiovascular study. In the current update of a previously reported analysis with an additional 5 years of follow up, the relationship between baseline PSA and advanced cancer diagnosis (T3 or greater) was further strengthened (odds ratio of 4.6 for a 1ng/ml rise in PSA) . There was a strong correlation between baseline PSA and prostate cancer diagnosis more than 25 years after the initial PSA value. Men who were 40 or younger when their blood was drawn were no exception. Nostradamus would be jealous.

Presented by JHans Lilja, MD, Angel M Cronin, MD, Peter T Scardino, MD, Anders Dahlin, MD, Anders Bjartell, MD, Goran Berglund, MD, David Ulmert, MD, Andrew J Vickers, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Re: PSA and CPPS

Posted: Thu Feb 17, 2011 1:30 am
by webslave
This report suggests that if you are over 55 and have a low PSA score, you may not need much further testing.
PSA Test Cut-off Could Signal Low-Risk Prostate Cancer

TUESDAY, Feb. 15 (HealthDay News) -- Men who have a low prostate-specific antigen (PSA) score when they're first tested may not need to be screened annually and probably don't need to undergo a biopsy, a new study suggests.

Dutch researchers presenting the findings at the Genitourinary Cancers Symposium in Orlando, Fla., said that few men with a PSA below 3.0 ng/ml were likely to develop prostate cancer and die of the disease.

"PSA can identify those at low risk of prostate cancer and once you have done that, you can remove almost 50 percent of men in the age group 55 to 74 [from undergoing biopsies]," said study senior author Monique Roobol, an epidemiologist in the department of urology at Erasmus University Medical Center in Rotterdam.

For this study, about 20,000 men aged 55 to 74 in the Rotterdam area were screened, with those having PSA scores at or above the cut-off of 3.0 sent for biopsies and additional screenings every four years. Eighty percent of men in the group had PSA levels below that threshold.

In this group of men, the higher the PSA level at baseline, the more likely the person was to develop prostate cancer and to die of the disease. Only 1.8 percent of men with PSA scores below 1.0 were diagnosed with prostate cancer, with only 0.04 percent dying of the disease. This compares with 15.7 percent of those with scores from 2 percent to 2.9 percent developing a malignancy and 0.36 percent dying of the disease.

"This gives us some confidence that annual PSA screening is going to soon become a thing of the past," said Dr. Nicholas J. Vogelzang, chair of the Developmental Therapeutics Committee of US Oncology, who moderated the teleconference. "A low PSA, particularly those in men who have less than 1.0, and probably those less than 2.0, certainly could be considered for substantially longer intervals of PSA screening... Personalization of PSA screening is clearly underway."
Update, 2013: Three PSA Tests Over Lifetime Sufficient for Many Men. Medscape. Apr 18, 2013.

Instead of routine prostate-specific antigen (PSA) screening — which has come under criticism in recent years amid concerns that it leads to overdiagnosis and overtreatment — just 3 PSA tests over the course of a lifetime is sufficient for many men.

In 2010, Dr. Vickers' team reported that a single PSA test at the 60 years of age is all that is needed for many men. That conclusion was criticized as being rather simplistic, because a single PSA test is just a "snapshot in time," whereas PSA is a "continuous variable" and it is important to have a number of data points. In an extension of that 2010 work, Dr. Vickers and colleagues offer a simple algorithm for prostate screening in a study published online April 16 in BMJ. For at least half of all men, it would mean only 3 PSA tests during their lifetime.

In their proposed strategy, all men with a reasonable life expectancy would be invited for PSA screening in their mid to late 40s.

Men who were found to have a PSA level below 1 ug/L on the initial test would be advised to return for screening in their early 50s and again at age 60. At the age of 60, men who still had a PSA level below 1 ug/L would be exempt from further screening.

Given existing data, these 3 PSA tests (mid to late 40s, early 50s, and 60) "are probably sufficient for at least half of men," the team concludes.

However, men who are found to have a PSA level of 1 ug/L or higher on the initial test are at above-average risk of developing life-threatening prostate cancer. These men should regularly undergo screening until around age 70. The literature suggests repeating the PSA test every 2 or 4 years, the researchers write.

For men 40 to 55 years, those with PSA levels in the top 10% of this age group should receive particular focus. This group contributes to close to half of all deaths from prostate cancer that occur before the age of 70 to 75, they add.

BMJ. Published online April 16, 2013.