Prostate-Specific Antigen (PSA) is a protein produced by the prostate gland, an organ in the male reproductive system located just below the bladder. This protein helps liquefy semen. A PSA test measures the amount of this protein in the blood. Elevated PSA levels can indicate various prostate conditions, including prostate cancer, and warrant further investigation.
Understanding PSA Levels in Older Men
A “normal” PSA level is not a universal number, particularly for older men. PSA levels naturally increase with age, reflecting changes in the prostate gland over time. For an 83-year-old man, a typical PSA range will be higher than for a younger individual.
A common reason for this rise is Benign Prostatic Hyperplasia (BPH), a non-cancerous condition where the prostate gland enlarges. Over 90% of men over 80 experience BPH, which can cause more PSA to leak into the bloodstream. This enlargement can squeeze the urethra, potentially leading to urinary symptoms, and contributes to higher PSA readings without indicating prostate cancer.
For men aged 70 and older, typical PSA levels can range up to 6.5 ng/mL. For those aged 80-84, a median PSA of 2.2 ng/mL and a 75th percentile of 4.7 ng/mL have been observed. Some guidelines suggest a PSA level greater than 10 ng/mL might warrant further evaluation for men aged 80-85. These figures are general guidelines, and individual variations occur.
Factors Influencing PSA Readings
Beyond aging and BPH, several other factors can influence PSA levels. Inflammation or infection of the prostate gland, known as prostatitis, can significantly raise PSA as inflamed tissue releases more PSA into the bloodstream. A urinary tract infection (UTI) can also cause a temporary PSA spike.
Recent activities or medical procedures can also affect readings. Ejaculation can temporarily increase PSA levels; avoiding sexual activity for 24 to 48 hours before a test is recommended for accuracy. Vigorous exercise, especially activities like cycling that pressure the perineum, can also cause a transient PSA elevation. It is advisable to avoid such activities for 48 to 72 hours before testing.
Medical interventions involving the prostate or urinary tract may also elevate PSA. A digital rectal exam (DRE) can cause a temporary increase, so the PSA blood test is often advised before a DRE. Prostate biopsies, cystoscopies, or catheterizations can elevate PSA for weeks or months. Certain medications, like testosterone replacement therapy, can also impact PSA levels.
Interpreting Elevated PSA Results
An elevated PSA reading in an 83-year-old man does not confirm prostate cancer but warrants thorough evaluation. Given the many non-cancerous factors influencing PSA, the initial step often involves repeating the test after addressing transient causes like recent ejaculation or infection. This re-test confirms if the elevation is persistent or temporary.
A Digital Rectal Exam (DRE) is a common complementary test. A doctor manually examines the prostate for abnormalities in size, shape, or texture. Neither a PSA test nor a DRE alone can definitively diagnose prostate cancer; they are screening tools suggesting further investigation.
If PSA remains elevated or DRE findings are suspicious, a multiparametric MRI (mpMRI) of the prostate is often the next step. This advanced imaging visualizes suspicious areas, helping determine if a biopsy is necessary and guiding it to specific areas. An MRI can also help avoid unnecessary biopsies for indolent (slow-growing) disease.
A prostate biopsy is the only definitive way to diagnose prostate cancer. Small tissue samples are taken from the prostate and examined under a microscope. For an 83-year-old man, the decision for biopsy or treatment considers his overall health, life expectancy, and preferences, as many prostate cancers in older men are slow-growing and may not cause harm in their lifetime.
Weighing the Benefits and Risks of PSA Testing
Deciding whether to undergo PSA testing, especially for an 83-year-old man, involves shared decision-making with a healthcare provider. This process weighs potential benefits against risks, considering the individual’s overall health, life expectancy, and personal values. PSA testing’s benefit lies in detecting prostate cancer early, which can lead to more effective treatment.
PSA testing carries several risks. One concern is false positives, where an elevated PSA suggests cancer when none is present. This can lead to unnecessary anxiety, additional doctor visits, and invasive follow-up procedures like biopsies, which carry risks such as infection, pain, and bleeding. Only about 25% of men biopsied due to elevated PSA are found to have prostate cancer.
Another risk is overdiagnosis, identifying slow-growing prostate cancer that may never cause symptoms or pose a threat. Such cancers are common in older men and may not require treatment. Overdiagnosis can lead to overtreatment, subjecting individuals to therapies like surgery or radiation with potential side effects such as urinary, bowel, and sexual dysfunction, without providing a survival benefit.
For elderly men, especially those with limited life expectancy or other serious health conditions, screening and treatment harms may outweigh benefits. Guidelines suggest men with less than a 10-year life expectancy may not benefit from routine PSA screening, as mortality benefits from early diagnosis may not be realized. The decision to test should be highly individualized, focusing on patient health goals and quality of life.