What is PSA and Why Does it Matter?
Prostate-specific antigen (PSA) is a protein produced by both normal and cancerous cells in the prostate gland, located below the bladder. PSA’s primary function is to help liquefy semen, aiding sperm motility.
The PSA test measures this protein in the blood and serves as a screening tool for potential prostate issues, including prostate cancer. It is important to understand that PSA is a marker, not a definitive diagnostic test for cancer on its own.
Understanding PSA Levels for a 70-Year-Old Man
PSA levels naturally increase with age, making age a significant factor in interpreting test results. For men aged 60 or older, a PSA level at or below 4.0 ng/mL is often considered a general benchmark. However, there isn’t a single universal cutoff for a “normal” or “high” PSA for a 70-year-old, as ranges can vary.
For men aged 70 and above, guidelines suggest a typical PSA range might extend up to 5 ng/mL, with some considering 5-7 ng/mL as potentially typical. Other sources indicate 0-6.5 ng/mL could be typical for this age group. A level exceeding 7 ng/mL for a 70-year-old is generally considered abnormal and may warrant further investigation.
Factors That Can Influence PSA Levels
An elevated PSA level does not automatically indicate prostate cancer; various non-cancerous conditions can also cause a rise. Benign prostatic hyperplasia (BPH), a common enlargement of the prostate with aging, can increase PSA levels because a larger prostate produces more PSA. Prostatitis, an inflammation or infection of the prostate gland, is another common cause for elevated PSA.
Recent ejaculation can temporarily increase PSA levels; abstaining from sexual activity for at least 48 hours before a PSA test is often recommended. Certain medical procedures, such as a digital rectal exam (DRE), prostate biopsy, or catheterization, can also temporarily elevate PSA levels. Urinary tract infections (UTIs) can also lead to an increase in PSA.
What Happens After an Elevated PSA Result?
If a 70-year-old man has an elevated PSA reading, the doctor will typically recommend further evaluation rather than immediately concluding cancer. A repeat PSA test is often performed to confirm the elevation, as levels can fluctuate. A digital rectal exam (DRE), where a doctor manually checks the prostate, may also be conducted.
If the PSA remains elevated or other concerns arise, additional diagnostic tests might be recommended. A prostate MRI is increasingly used to provide detailed images of the prostate, helping to identify suspicious areas and guide subsequent procedures. If a suspicious lesion is identified on the MRI, a prostate biopsy, which involves taking tissue samples, may be recommended to definitively determine if cancer is present.
Making Informed Decisions About PSA Screening
For men in their 70s, the decision regarding PSA screening involves a discussion with their doctor about the potential benefits and harms. While early detection can lead to more treatable cancer, there are risks such as false positives, anxiety, and potential overtreatment for slow-growing cancers that might never cause harm.
Some medical organizations suggest that routine screening for men over 70 is generally not recommended, while others emphasize individualized decisions based on health status and life expectancy. Shared decision-making between the patient and physician is important, considering the patient’s overall health, life expectancy, and personal preferences. Understanding that PSA is a screening tool with limitations allows for a more balanced approach to prostate health management.