At what psa is PCa suspected?

[CousinGrandpa]

my 45 year old son has a psa of 0.79. No PCa diagnosis. Should he be concerned? (Dad with PCa)

[DAR1890]

has he seen a urologist? Has he had a DRE? I would consult his PCP for a possible referral to a urologist. 🙏🙏

[JohnInTheMiddle in reply to DAR1890]

PSA tests good. DRE has poor diagnostic value, as in my DRE was fine, right up to missing metastatic disease. Studies confirm. Some cancers caught. Some missed.

[tn12]

0.79? Really?

[witantric]

0.79 is very low! Just relax and be vigilant. Maybe PSA tests every year. That’s all what I would do right now.

[Tall_Allen]

That's about as good as it gets.

[JohnInTheMiddle in reply to Tall_Allen]

Is it correct to say "normal male existence is associated with a non-zero PSA"? (Which goes up and down daily etc?) The question sort of implies any PSA is a concern, but this is not true...?

[Tall_Allen in reply to JohnInTheMiddle]

I didn't read that inference into his post - I thought he was just asking. In fact, MSKCC has a "thrice in a lifetime" protocol (my term, not theirs). They found that if PSA is below 1 once in a man's forties, he is good for 10 years. If he continues to have a PSA below 1 once in his 50's, he is good for another ten years. If he continues to have a PSA below 1 once in his 60's, he need never have another PSA test.

[JohnInTheMiddle in reply to Tall_Allen]

Thanks TA. I'm going to read between the lines again and ask another question. I think the implication here is that PSA should kind of, sort of, not be in the bloodstream in a healthy man? PSA has its job of liquefying semen and performing other reproduction-related tasks, as we know.

So thinking about that then, one can conclude that any PSA in the blood is because of some sort of leakage unrelated to reproduction or sex. But what you are saying is that a little leakage is okay.

The prostate is a complicated organ and a little PSA gets away. So we don't worry about PSA in the blood - unless it's more than we would expect from normal "leakage". We start to worry if we see higher PSA levels in the blood, levels that would be evidence of production of PSA by rogue prostate cells.

Is this a correct understanding?

[Tall_Allen in reply to JohnInTheMiddle]

PSA from sex, bike riding, BPH, and prostatitis are all benign sources. Prostate glands leak PSA normally as we age.

[NanoMRI]

Several centers are discussing/promoting "Smarter Screening". Essentially, screen all men in their 40's looking for PSA below 1.0 and further investigation when above. Dr Matt Cooperberg, UCSF, has YouTube videos discussing this. As mentioned, DREs miss many a cancers; mine did. With family history, an mpMRI, (at some point), might provide further confidence. I found mine to be crucial.

[Mascouche]

It used to be that doctors were unconcerned with PSA that were below 4.0. That was probably too lax.

The lower the PSA, the better/safer and unless someone's had their prostate surgically removed, 0.79 is a pretty good number.

Keep in mind that PSA does not directly measure cancer, it measures how much of a Prostate Specific Antigen is in your blood. So if you have a prostate, it it normal to have a PSA above 0.

More important that your son's number is the relative stability of his PSA levels from tests to tests. There can be some normal fluctuations related to bicycle rides or ejaculations in the 3 days before testing. So tell you son to abstain from those at least 3 days before his next test. Unless you seen that his PSA levels are on the rise for 3 tests in a row, he (and you) probably should not be worrying about this.

Hope this helps!

[CousinGrandpa in reply to Mascouche]

Thank you!

[Huzzah1]

In my case, a DRE caught my PCa. My PSA was 3.5 and my GP told me my prostate was enlarged and he felt some firmness on the left side. Long story short, he sent me to a Uro and I have Gleason 9 cancer with 3 mets in the pelvis.

[JohnInTheMiddle in reply to Huzzah1]

I'm almost exactly the same age as you Huzzah. And also with mets to bone and lymph nodes.Your comment about "a DRE caught my PCa" however is missing a few things. It's missing rage. And it's missing "after metastasis had already occurred".

I don't want anyone reading this thinking that at DRE is an acceptable diagnostic for prostate cancer. A DRE has poor diagnostic sensitivity. In my case it completely missed metastatic prostate cancer. I had to wait for excruciating back pain for that. Also my doctor was prejudiced against PSA testing.

The only test for prostate cancer that's worth doing is a PSA annually, and likely coupled with an MRI.

Here's my popular write-up on this topic, done in the period after diagnosis and the initiation of therapy:

PSA Testing Scandal - Lost Years of Life - Updated re: QoL

healthunlocked.com/advanced...

[MrG68]

PSA tests are used both in treatments and diagnosis of PCa. Some people with low PSA can have cancer. Some people with high PSA don't have cancer. The recognised threashold for psa is 4. Some even take it lower than the 4. If you go over this, you'll probably get a referal.

Here's the rub. The 4 figure was literally made up. The company who designed the test got asked about what figure and they arbirarily said 4. This is documented in Richard J. Ablins book - he's the guy who discovered the PSA.

The take away, for me personally, is people are different and you shouldn't rely on this test in its entirety. You should consider using this test as a way of examining its rate of change once you establish a base line to a time series of results. This will give an indication to a possible growth. A time series is important, again IMO, because the test isn't a perfect test. Various things can give false readings. You can even potentially get 2 different readings from tests that are done at the same time.

Use the test as part of your strategy with other information and not by itself.

That aside, the value of 0.79 is WAY down on the low side. It's a dream result really.

The thing to do though, is to just monitor and document it and keep an eye out for rates of change. What you can do is put the data in Excel and draw a best fit line. The slope of the curve will signify a rate of change. If the slope increases, it indicates an increased rate of change.

Hope that helps.

[Professorgary]

if you are concerned, request a total and free when he is due for his next Psa test.

[j-o-h-n]

DRE's are considered irrelevant? Shoot....there goes all the fun............

Good Luck, Good Health and Good Humor.

j-o-h-n