Prostate-Specific Antigen (PSA) is a protein produced by prostate gland cells. Both healthy and cancerous cells create PSA, with a small amount circulating in the blood. A blood test measures PSA levels to assess prostate health. While associated with prostate cancer screening, PSA is a marker, not a definitive diagnostic tool.
PSA Levels in Older Men
A “normal” PSA level for an 85-year-old man is not a single, fixed number. PSA levels naturally increase with age, even without prostate disease. This rise is due to the prostate gland enlarging (benign prostatic hyperplasia or BPH), leading to higher PSA levels.
Medical organizations provide varying age-specific reference ranges. For men aged 70 and above, some guidelines suggest a “normal” PSA level up to 6.5 ng/mL. For men aged 85 and older, the 95th percentile can range higher, with some studies indicating values up to 33.17 ng/mL. One study found the median PSA for men aged 80-84 was 2.2 ng/mL (95th percentile 4.7 ng/mL), and for men aged 85-89, the 95th percentile reached 10.2 ng/mL.
No universal threshold definitively indicates cancer at any age. Healthcare providers consider age, overall health, and other factors when interpreting PSA results. A PSA level concerning in a younger individual might be expected for an 85-year-old. The trend of PSA levels over time provides more meaningful information than a single reading.
Other Influences on PSA Readings
Several factors beyond age and prostate cancer can influence PSA levels. Benign prostatic hyperplasia (BPH), an enlarged prostate, is a frequent cause of increased PSA. Prostate inflammation (prostatitis) can also elevate PSA, allowing more to enter the bloodstream.
Urinary tract infections (UTIs) are another common cause of elevated PSA, as infections irritate the prostate. Medical procedures involving the prostate or urinary tract (e.g., biopsy, cystoscopy, catheterization) can also significantly raise PSA levels due to temporary irritation or inflammation.
Activities like recent ejaculation or vigorous exercise (e.g., cycling) can temporarily increase PSA levels. Patients are advised to avoid ejaculation for 48 hours and strenuous activity before a PSA test for accurate results. Even a digital rectal examination (DRE) can cause a slight, temporary rise.
Beyond the PSA Test
An elevated PSA level in an 85-year-old man does not confirm prostate cancer; it indicates a need for further investigation. If elevated, a doctor might recommend a repeat PSA test, sometimes after addressing influencing factors. A digital rectal examination (DRE) is performed to check for prostate abnormalities.
Further diagnostic tests include multi-parametric MRI to identify suspicious areas. If concerns persist, a prostate biopsy may be recommended, involving tissue samples for microscopic examination. The decision to pursue these invasive tests in an 85-year-old involves careful consideration of overall health, other medical conditions, and life expectancy.
For many older men, especially those with limited life expectancy or significant health issues, immediate aggressive prostate cancer treatment may not be beneficial. Prostate cancer grows slowly, and for some, treatment side effects could outweigh benefits. Active surveillance or watchful waiting are appropriate strategies.
Active surveillance involves close monitoring with regular PSA tests, DREs, and sometimes repeat MRIs or biopsies, with intent to treat if cancer progresses. Watchful waiting, a less intensive approach, focuses on managing symptoms without aiming for curative treatment. Shared decision-making between the patient, family, and healthcare team is central to determining the most suitable path.