PSA Test

Posted by lengarrett @lengarrett, Jan 17, 2023

I'm 72. My father and grandfather both had prostate cancer. My PSA last year was 1.5. This year it is 2.41. Should I get retested?

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PSA test scores change regularly. You are not greater than 4 so there is likely no need to immediately get tested again. Best advice will come from your urologist. If you are concerned about Prostate Cancer, it may be worth reading Dr. Walsh's "Surviving Prostate Cancer". I am not a doctor, but I would not be losing sleep over your 2.41 score. I would however get it tested again in a few months.

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Since you're coming here and asking that question, that would lead me to think you're already somewhat concerned, and good for you for keeping track with that family history.

I'm with Jb2buck though, that's a pretty low score, and as was pointed out, a lot of things are said to be able to effect your psa. Sex, certain exercises, dehydration etc..

As suggested, if it concerns you, tell your doc you'd like to get checked again in say 3-6 mos. What's a few minutes and a few drops of blood for some peace of mind?

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Another lay person weighing in here: agree with above comments.
Would add that the velocity or acceleration of PSA is a factor; not just the number.

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In my prior life. My life before prostate cancer. I would say no rush. In my new life. My life with prostate cancer. I say let your primary care doc make the call and begin a self-directed watchful waiting program.

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@jb2buckwater

PSA test scores change regularly. You are not greater than 4 so there is likely no need to immediately get tested again. Best advice will come from your urologist. If you are concerned about Prostate Cancer, it may be worth reading Dr. Walsh's "Surviving Prostate Cancer". I am not a doctor, but I would not be losing sleep over your 2.41 score. I would however get it tested again in a few months.

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Thanks so much.

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@jb2buckwater

PSA test scores change regularly. You are not greater than 4 so there is likely no need to immediately get tested again. Best advice will come from your urologist. If you are concerned about Prostate Cancer, it may be worth reading Dr. Walsh's "Surviving Prostate Cancer". I am not a doctor, but I would not be losing sleep over your 2.41 score. I would however get it tested again in a few months.

Jump to this post

Do not look at the absolute value. The 4 ng/ml cutoff has done much damage by delaying life saving treatment for those under 4.. There are large numbers of prostate cancer patients with significant disease with values such as 2. On the other hand, there are also patients with a 4ng/mL higher who were treated unnecessarily, because there are several reasons for PSA values to fluctuate unrelated to cancer.

So, what to do, The proper way to use PSA is to track it over time and look for a progressive rise over time. This patient needs more frequent testing, particularly with a family history. It should start now.

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I had nearly the same story. Dad and brother both had prostate cancer. On an annual exam my psa was 2.4. Waited 12 months to recheck and psa was 4.5 with digital exam revealing lumps. Had biopsy which resulted in Gleason 8 and 6. Just had surgery 1 week ago which went well but go in for pathology results tomorrow. Looking back I should have had psa rechecked at 3 or 6 months after psa hit 2.4 and would have caught earlier. Happy to answer any other questions. Take care.

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@drj

Do not look at the absolute value. The 4 ng/ml cutoff has done much damage by delaying life saving treatment for those under 4.. There are large numbers of prostate cancer patients with significant disease with values such as 2. On the other hand, there are also patients with a 4ng/mL higher who were treated unnecessarily, because there are several reasons for PSA values to fluctuate unrelated to cancer.

So, what to do, The proper way to use PSA is to track it over time and look for a progressive rise over time. This patient needs more frequent testing, particularly with a family history. It should start now.

Jump to this post

Agree. a good reason to get tested in a few months.

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For men under the age of 40, a 95% cutoff was found to be closer to < 1.8 ng/mL (Johns Hopkins). The cut off of 4 ng/mL was using a random selection of men without any consideration of age. But, all that means little. Someone once used the term PSA velocity; not a bad term. I simple used monitoring over time ... same thing. That is what everyone should be doing.

One cautionary note: One can order a % free PSA, as I did to try to help resolve the level of concern for an elevated PSA, but I found it borderline useful at best. In fact, it kinda confounds things, and helped me down a dangerous path which had weak validation data. It caused me to hesitate acting on total PSA levels and rate of change staring me in the face. when I should have acted sooner. A casualty of Covid.

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