PSA levels increase. When to be concerned?

Generally speaking, PSA levels rise slightly with age and a PSA reading may be a result of enlarged prostate. Given that the PSA levels are not significantly increasing, I would suggest that being somewhat educated (kudos for you to be on this forum!) is a reasonable approach and following up with the health team. There are so many paths to travel, but the idea of "active surveillance" is a construct where you are educated/informed/aware and hold-off on taking action until criteria are met. (I'm 53 and had my prostate removed when I was 41 and just recently finished 2 years of ADT or a recurrence).

You are in a good spot and I'm sure many others will chime in.

Maybe an MRI can determine if there really is a problem. It could be BPH and an antibiotic might get him back down even more.

Good urologists can investigate this issue and figure out whether there really is a problem.

PSA blood tests normally fluctuate depending on the lab, whether the patient recently had sex or rode a bicycle, etc etc.

I will ask if your husband has African or Caribbean ancestry. If so, then he has a higher risk profile for prostate cancer and needs to be a bit more proactive.

Otherwise, in my entirely non-professional opinion, a sudden (but small) jump like that might justify a little more active monitoring, but nothing more than that at this stage.

I've seen a very loose rule of thumb that when your PSA hits 10 there's a 50% chance it's due to prostate cancer (usually mild and curable at that early stage), but there are probably lots of caveats and exceptions, so don't take that number too seriously; it's just to show that 3-ish is still very low, relatively speaking.

I agree with the previous comments that you're probably in a pretty good spot. 25 years ago my PSA spiked from about 1.0 to 4.0 and stayed there for almost a year. Back then, the next step was a biopsy (the old way, ugh) and I had 2 biopsies before it dropped back down to 1.0 on it's own. I wish the urologist would have put me on an antibiotic back then as it was probably just an infection (but who knows). That said, neither would I ignore a rising PSA. I'd suggest working with the urologist and see where it leads. It'll probably just go back down or flatten out, but if it doesn't I'd expect the next step is probably not a biopsy, but rather simply an MRI. That's what my urologist recommended when my PSA started rising earlier this year. For me (as a healthy 70 year old) the 3T MRI with contrast was an easy test, although I guess for some folks it can be more difficult. The MRI revealed a lesion the radiologist report said was about 50% chance of being cancer, so I then had a fusion biopsy which found prostate cancer. But I do want to leave you with one caution. My brothers PSA never got to 3.0, but his PC had already gotten out of the prostate and was aggressive. Within the last year my PSA never got over 4.25 and had dropped back to 3.26 on the retest right before my MRI, but I ended up having what my very experienced surgeon at a cancer center of excellence called "a heavy load of cancer" in my prostate with both Cribiform and IDC found (very not good). So while an overall low PSA is definitely a very good thing, it's no guarantee and I suspect that's partly why the rate of change is also closely monitored. So I'd suggest you continue to follow up on this, but (again) I wouldn't be overly concerned yet. It's probably nothing, but it's better to be safe rather than sorry. BTW, I'm not a medical professional nor do I have any special expertise in this area. Best wishes.

@debdebkrz
I wonder why not every 3 months on monitoring. After my radiation treatments I was for 3 years to have every six months PSA test. The goal was to get below 1.

It is very common to have rise and fall of PSA tests. It is the continuing rise that becomes a problem. I was told that even constipation can cause PSA to rise as the prostrate and rectum are so close.

I am a long distance bike rider. I try not to ride 1 week prior to my PSA tests. But I am sure I am aggravating my PSA as really sore. I had a slight rise in my PSA in my last 3 month check (.44 to .55) and was told was common and just would watch. But I have a PSA test every 3 months not the 6 months you mentioned. This was the requirement from UFHPTI and my Mayo PCP.

PSA blood tests are so cheap and non-invasive (CA $30–40 in Canada – US $22–30 — if not covered by provincial healthcare) that there's no reason not to get them frequently if there's a shadow of concern, even if insurance won't cover all of them. The important thing is just to avoid overreacting to small changes.

To screen for breast cancer, women have to have their breasts more-or-less squeezed flat in a giant vice during the mammogram. Imagine if we had to do that with our testicles to test for prostate cancer! 🤢 We really have it easy, guys.

That made me laugh out loud!

@northoftheborder, @akiwi

Since we trying to determine if the prostrate has cancer it would require squeezing our prostate gland. Now that would really be something wouldn't it.

Yes a good laugh by northof border and I too enjoyed it. Prostrate cancer, stay away from our testicles or they may come up with this type test also.

Generally, under 4. is acceptable. Read and review the many articles reference aging and PSA levels. The issue is velocity or the rate of increase in the PSA. Tests should be done every six (6) months to measure the changes in PSA levels. The next step would include an MRI or other to reveal any lesions or other within the prostate gland.
If so, then normally a biopsy is done to validate Yes or no.

Read, and research to be able to ask the right questions. Also, obtaining a second opinion is always prudent because the replies you receive from your doctor or subjective. Experience in this field is important.

I was informed early in testing my psa ( I was in my mis 50’s) psa under 4 was not alarming. I hit 4.5 at 57.
Then was told to see urology. Biopsy confirmed pc Gleason 6. Active surveillance led to more biopsies and mri’s periodically.
Genomic test indicated the slow growth variety but at age 65 a targeted biopsy into an mri detected lesion confirmed 3+4=7.
So long story short, prostatectomy 3 years ago today and recently tested psa less than .1 is commonly regarded as undetectable.
Don’t panic but keep an eye on things regularly is my suggestion.