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My PSA is gradually going up
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An_216400 posted:
My PSA reading was 0.9 about five years back. Now my PSA reading is 2.3. My age is about 80 years. Whether this increase of PSA indicate any adverse information regarding my prostate. As such I have no problem of prostate at present, but as per doctor's advise I did the tests. Please post your comments and oblige.
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Galileo1962 responded:
Anon_12223,
I'm just a prostate cancer patient, and I imagine you want Dr. Moul to answer your question. While you wait for him, I hope you don't mind if I step in. I thought I would tell you that from my experience and reading (especially Dr. Walsh's book) I would not be concerned, as long as your DREs (the rectal exams) are normal and you are not experiencing any symptoms.

The reason I say this is that your age-specific PSA is fine.
According to Dr. Catalona ( http://www.drcatalona.com/quest/Spring04/quest_spring04_1.asp ) the usual trigger for a biopsy in a man your age is a PSA of 6.5. Also, your PSA velocity is pretty slow. The rule-of-thumb is 0.75 ng/ml per year, and you're well below that.

The odds seem pretty low, in this layperson's opinion, that you will ever be threatened by prostate cancer.

I am, of course, interested in Dr. Moul's comments, as well as those of my friend John, az4peaks, who knows far more than I do about these things.

Best wishes to you.
 
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Galileo1962 replied to Galileo1962's response:
After I wrote my previous reply, I realize I misrepresented what Dr. Catalona meant. However, your PSA still seems low, for an 80 year old man, to me. I certainly wouldn't be signing up for a biopsy with your stats! :)

The urology department at New York University (at http://urology.med.nyu.edu/conditions-we-treat/prostate-cancer/screening ) says:

"Further evaluation, in the form of a biopsy , is recommended for:
  • Men under age 60 with a PSA greater than 2.5
  • Men over age 60 with a PSA greater than 4.0
  • Any man with PSA rising more than 25% per year or 0.75 ng/ml per year"
and you don't fall into any of those categories.

I also would like to hear John and Dr. Moul's opinion of the value of PSA testing in men 80 and over. I understand that the current thinking is that beginning around age 75, screening is more discretionary between doctor and patient than at younger ages, and it would seem that men in their 80's who show no signs or symptoms of prostate cancer, and who have a good PSA/DRE record up to that point, could just drop it.

Of course, that's my nonprofessional opinion only!

Best wishes.
 
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az4peaks2 responded:
Hi Anon, - I'm not sure what "about" 80 means in real age. I suspected that the number following your ID was a birth date and if so you would 86.

The only reason this is important relates to the expected actuarial life expectancy. Regardless, the question that you posed is whether the increase in PSA is an adverse event. My IMPRESSION is probably not!

Here is my logic for this response:

1) your PSA has increased over the last 5 years by 1.4 ng/ml, but has only reached a level of 2.3. Again age is very important here. Although the increase is approximately 150%, at such low levels it could well be attributed to BPH (Benign Prostate Hypertrophy) which is the natural growth of the Prostate affecting most men as they age.

Your PSA is actually quite low for a man in his 80's and since PSA is volume related BPH is a real and logical consideration. In addition, there are other benign (non-Cancerous) reasons for temporary increases in PSA levels, that can affect any single PSA test and so it is more meaningful to have a PSA history of results, to see if any trend in PSA readings is present.

2) At 80, your actuarial Life Expectancy is 9.6 years according to the Social Security tables, by which we are all going to be measured under the newly passed health legislation, and of course is reduced as further aging occurs.

3) The PSA test is generally recommended to be offered to men with at least a 10 year life expectancy.

4) The median age for men diagnosed with Prostate Cancer (PCa) is 69 and the median age for men dying from PCa is 79. Most in both categories usually have substantially higher PSA readings than yours.

All and all, it would appear that being an apparently asymptomatic (without symptons), elderly man, with generally favorable PSA levels, the chance of your having clinically significant PCa is relatively small.

Even if PCa was present, at your advanced age, the chances of adverse effects from any treatment for it, would likely far outweigh any life extending benefit they might provide. Therefore, I would suggest you give serious consideration to continuing whatever you are doing. You may wish to abandon further PSA testing and not worry any further, about the possibility of Prostate Cancer, unless some clinical symptoms would arise that adversely affect your day to day living. You seem to be doing quite well.

These are my OPINIONS and although I consider myself a well informed layman with a 30 year involvement in the American Health-care System, I am NOT a Physician and I always recommend that you verify what I have said here, with your professional advisor(s).

I will be interested in any reply from Dr. Moul, for whom i have great respect and have followed his career from when he headed the Department of Defense PCa research program. Good luck - John@newPCa.org (aka) az4peaks





If you were found to have PCa, the likelihood of causing your mortality is far less than the potential
 
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An_216401 responded:
Just one additional comment, and I don't know that it would change any recommendations already made. Unless there are PSA values taken in between the 0.9 and 2.3, you cannot assume that it is "gradually" going up (i.e. in a linear fashion) over the 5 year period.
 
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Judd W Moul, MD replied to An_216401's response:
In general, a PSA level of 2.3 ng/ml is a normal and good PSA reading for an 80 year old man. Some studies have suggested that if a man lives to 70-75 years and still has a PSA reading less than 3.0 ng/ml then no further testing is needed during his lifetime since his risk for serious prostate cancer is very low. However, if you are concerned you should see a urologist.


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