Except for prostate cancer, the two primary causes of PSA rise are
benign prostatic hypertrophy (BPH) and prostatitis.  BPH happens as men
age, and it should stay at the same level or increase, but relatively
slowly.  It would unlikely to be a reason for an increase in PSA in a
younger man.  Prostatitis (inflammation of the prostate) can happen for
a variety of reasons.  If it results from an acute infection, it can be
treated with antibiotics and the PSA level should decline but I think
the amount of time that takes can be quite variable.  Chronic prosatitis
often doesn't respond to antibiotics and persists for quite a long time.
  If it is not clear to your doctor why your PSA increased, he will
probably order a biopsy.

A digital rectal exam should be routine in men past a certain age.   It
is an independent test for prostate cancer and can also help monitor the
development of BPH.   In addition, the doctor can check for hemmorhoids
and abnormalities of the rectal wall, including rectal cancer.   Some
doctors can manage to extract a small stool sample when doing a DRE and
 use it to check for occult blood in the GI tract.  It is such an easy
test that there is no reason not to do it.   Every primary care doctor
I've had since my 30s has done a DRE.

I waited as long as I did because at the time (2003) there were a lot
of people including my doctors who felt all was OK as long as the PSA
was below 4.0.  I too was of course in denial.  As you can guess, the
biopsy was indeed positive, had surgery a couple of months later.
Dave Perry

You are right.  The worst time for me was worrying about the surgery before
it happened, especially since I never had any major surgery before.   After
the surgery I was uncomfortable, but at least I knew that healing was taking
place.

Yes, it is confusing.  I have a friend in his late 50's who has had
PSA's between 5.0 and 6.0 for roughly five years (zero velocity) with
no evidence of cancer in two biopsies.  Another, age 75, had a PSA of
22 (up from less than 4.0 a few years earlier) with no evidence of
cancer in the biopsy followed six months later by another PSA of 24
with nothing on the second biopsy.  Of course, a biopsy is just a
sampling, not definitive against the presence of cancer.  Since PCa is
usually multifocal, it's like trying to find raisins in a loaf of
raisin bread by sticking straws into the bread.  Sometimes the raisins
are all over the place but you never hit a one.

Of course, the higher the PSA, the more likely you are to have cancer
but it appears just as everyone here has pointed out that the PSA
velocity is much more important.  At the time of my diagnosis, any
increase of more than 0.75 per year was considered suspicious.  Mine
was almost exactly 0.75 (2.8 to 4.9 in three years).  Incidently, my
PSA had dropped back down to 3.8 just a few days before surgery  when
my uro wanted to test it one more time "for a baseline."  If I didn't
have that 4.9 which prompted the biopsy, my cancerous prostate might
still be inside me instead of smeared on glass slides in a lab storage
vault since my PSA would have gone from 3.6 to 3.8 in just about two
years and it would have been "nothing to worry about" according to my
GP.  Hah!

Finally, it sounds as if you are a bit concerned over the "need to have
a biopsy."  The greatest fear I had during my entire PCa ordeal was
going for the biopsy, much more than the surgery itself.  I was so
scared I could hardly walk.  It turned out to be nothing.  No worse
than a DRE.  I did have a numbing agent injected so that may have
helped.    Anyway, good luck with that next PSA.
Dave Perry

I am not a doctor, but, based solely on the information you provided (great
information, too), I would say that if you are at 3.0 at 60, you need not
worry about being 4.0 at 70.  However, if you are at 0.4 at 63 and 1.8 at 65
and 3.2 at 66, you need a biopsy and you still haven't gotten to 4.0.

Jack, I hope I do not confuse you so please discuss this with your
Physician. Ranges by age and number is the old method of judging wj\hether
one is a high candidate for PCa. About 18 months ago the PCA Industry
changed because a lot of people where diagnosed with PCa well below the
established ranges.

Today the general thought is Velocity; ie, the rate of change in the PSA
when measured against Time. For example, if one's PSA for the past ten years
was 1.1 and last January it was 1.8 and today it was 2.8 and the age was say
60 years old, then there would be concern and a biopsy would be appropriate.
In this example the 2.8 is well below the 4.0 measure, but is increasing
about 2.5 fold in the past year.

I am not a Doctor. However, there are Doctors, like my comapany assigned
HMO, that was not aware nor well read, and therefore when my PSA went from
2.2 to 3.5 at age 54 was not concerned. So "not concerned" was he that when
it went to 4.0, he did not botehr to tell me......

So I am screwed......