Median values of PSA with selected age groups

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Dick Smith - 13 Sep 2006 01:01 GMT

Dr Catalona states:
"In my PSA Study, the median PSA value for the age group of men without
clinical evidence of prostate cancer is 0.7 for men in their 40s, 0.9
for men in their 50s and 1.4 for men 60 years of age or older.

If the PSA is at the median or less for the age group, then the risk
for prostate cancer is very low. If a man's PSA is higher than the
median for his age group, his risk of having prostate cancer is higher
and the risk that the cancer is aggressive is higher. The higher the
PSA, the higher the risk for cancer and aggressive cancer."

I have a family history of PCa. I'm 38. My PSA test has come back as .8
and .7 for the past two years, respective. I'm not sure if this is
acceptable for my age or if I'm slightly above the median value.
However, my question is what does one do when they are in their 40's
and their PSA is above the median value, say 1.2. Does that warrant a
biopsy? What if there is a family history of PCA?

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Bob Anthony - 13 Sep 2006 03:40 GMT

You may need multiple biopsies to find out. If then. At age 38 with a
.8, could be a possibility. I remember a member here on this ng that had
a .7 psa at 37 and was dx'd with pca.
I wish I knew years ago what you know now. Whatever the case may be, you
are very very early to wipe pca out of you life, if it is PCa at all.
Seems to me that you need to track you psa's. Here's a link to just that.
www.dryew.com/downloads/PSA.pdf

B.A.

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Dick Smith - 13 Sep 2006 05:35 GMT

> You may need multiple biopsies to find out. If then. At age 38 with a
> .8, could be a possibility. I remember a member here on this ng that had
[quoted text clipped - 5 lines]
>
> B.A.

Thank you for the reply Bob.

I'm not sure if I'm really too comfortable with my numbers. With .7
being a the "cut off" for a man in his 40's and I'm at .8 at age 37 and
.7 at age 38, I'm really not too sure what to expect or do. I do know,
no matter what I tell my doctors, they will basically brush me off. I
don't even know if I can get a fPSA test done, let alone find a
urologist willing to do a biopsy. It seems many of them still go with
the standard 4.0 or 2.5 as static numbers not taking into account age.
Geez, my wife and I are now just planning on having kids!

I have to take PCa serious because it took my fathers life. I saw what
it did.

I did find this study.

OBJECTIVES: Limited data are available concerning the extent to which
the initial prostate-specific antigen (PSA) measurement in men younger
than age 60 predicts for the risk of prostate cancer (CaP) and how this
compares to other known risk factors. METHODS: From 1991 to 2001,
13,943 men younger than 60 years old participated in a CaP screening
study. Men aged 40 to 49 years were eligible for the study if they had
a positive family history or African-American heritage, and men older
than 50 years were screened without respect to risk factors. The CaP
detection rate, PSA velocity, pathologic features, and treatment
outcomes were evaluated as a function of the baseline PSA level.
RESULTS: The median PSA level was 0.7 ng/mL for men aged 40 to 49 years
and 0.9 ng/mL for men aged 50 to 59. A baseline PSA level between the
median and 2.5 ng/mL was associated with a 14.6-fold and 7.6-fold
increased risk of CaP in men aged 40 to 49 and 50 to 59 years,
respectively. A greater baseline PSA value was also associated with a
significantly greater PSA velocity, more aggressive tumor features, a
greater biochemical progression rate, and a trend toward a greater
cancer-specific mortality rate. CONCLUSIONS: In men younger than 60, a
baseline PSA value between the age-specific median and 2.5 ng/mL was a
significant predictor of later CaP and was associated with a
significantly greater PSA velocity. A young man's baseline PSA value
was a stronger predictor of CaP than family history, race, or
suspicious digital rectal examination findings. A greater baseline PSA
level was associated with significantly more adverse pathologic
features and biochemical progression.

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Bob Anthony - 13 Sep 2006 17:49 GMT

> The median PSA level was 0.7 ng/mL for men aged 40 to 49 years
> and 0.9 ng/mL for men aged 50 to 59. A baseline PSA level between the
> median and 2.5 ng/mL was associated with a 14.6-fold and 7.6-fold
> increased risk of CaP in men aged 40 to 49 and 50 to 59 years,
> respectively.

Dick:

I do admit that this study is a bit unnerving. Maybe some of the other
members here will offer their opinions as well.

I would go for the fPSA test, even if you have to pay for it yourself.
It may shed some light as to what, if anything in your case, is actually
going on. Find a doctor who specializes in PCa and discuss your feelings
and concerns with him. Especially about your possible genetic
predisposition for PCa because of your father. You may find out if your
PSA results could be PCa related and proceed from there with a biopsy or
you may find out that quite possibly nothing is going on. Except maybe
some BPH or other more benign and less serious conditions. Either way,
you should track all of your future PSA's and in the unfortunate event
that you do need treatment for PCa, you will know that you have jumped
on it in it's very very early stages.

B.A.

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ron - 13 Sep 2006 20:02 GMT

> Dr Catalona states:
> "In my PSA Study, the median PSA value for the age group of men without
[quoted text clipped - 13 lines]
> and their PSA is above the median value, say 1.2. Does that warrant a
> biopsy? What if there is a family history of PCA?

Hi Dick...Given your family history you were wise to start PSA testing
at an early age. This will allow you to determine your baseline PSA
and determine your PSA doubling time. As you are probably aware, the
rate of PSA change seems to be more important that the absolute PSA
value (at least for PSA<10). If your rate of PSA increase ever gets
appreciable (either an absolute increase > 0.5-.75 in a single year, or
a doubling time less than something like 7-8 years) then further
investigation would seem appropriate. If you live near Drs. Bahn or
Lee you could get a power / color doppler imaging analysis performed
(I've heard that MD Anderson and MSK now have good capabilities in this
area too; UCSF has endorectal MRI). These techniques allow for high
resolution imaging, and, if anything suspicious is seen a targeted
biopsy could be performed...Best wishes and good health, ron

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