Prostate Specific Antigen (shortened to PSA going forward in this discussion) is not cancer specific. It is a protein excreted from the normal, cancerous or benign Prostate. The logical question then is: How much PSA in the blood is normal and when do we start to worry? Obviously, this is the million-dollar question that leads to happy results or the dreaded biopsy, which is the only way to actually detect Prostate cancer.
We need to take a quick side trip and discuss how PSA is actually measured and reported. It is measured with a simple blood test. It is then reported in nanograms per milliliter of blood. It is also nice to know that a nanogram is a billionth of a gram! It is very small!!
The universally accepted normal number is 4.0 ng/ml and for our purposes we will simply use the number, such as 4. But what is the importance of the number 4, and more importantly, how was it decided that 4 is normal? This is a very interesting question because there are no scientific papers that support this number. To the contrary, it is universally accepted that there is NO NORMAL PSA number. A man could have Prostate cancer with a PSA of 2.0 and another man could have a PSA of 11.0 and not have cancer.
Now we are getting somewhere, maybe?! If there is no normal number for a man to relax and know his PSA is OK, then what is the point of measuring PSA in the first place? I suggest it is for Benjamin! Money, as in there is no money in healthy people. We need sickness to monetize any disease or condition.
After saying the above, it is very interesting to find several “scientific” web sites, including the American Urological Association that list so called “normal” PSA numbers by decade of life beginning in the fifth decade of life. Keep in mind that no doctor should suggest a PSA blood test for any man below the age of 40 and even then anyone below 45 should be asking many questions of why a doctor wants to do this test at such a young age! The only logical answer to any question would be that the doctor has many unpaid bills that need revenue to pay!! Anyway, here are numbers by decade and what is considered normal for PSA. If you are a man between the ages of 40 and 49, a normal PSA number should be at or below 2.5 ng/mL. If you are a man between the ages of 50 and 59 years of age a PSA of 3.5 ng/mL or below would be considered normal. For a 60-69 year old male, that number should be at or below 4.5 ng/mL. If a man is 70-79 years of age their normal PSA should be at or below 6.5 ng/mL Writer’s note: If I were anywhere near or above 70, I would not walk out of any doctor’s office that suggests a PSA test, I would run!! The last milestone in this discussion is that if any man, at any age, has a 0.75ng/mL PSA increase year over year, it is perceived as a warning sign that he may have Prostate cancer. The doctor would normally go to an MRI or Ultrasound test as the next step before proceeding to a biopsy to determine if the patient has Prostate cancer.
I find the above discussion to be fascinating because I do not believe many doctors following any of these guidelines. If your PSA isa above 4.0 they will want to send you to a Urologist and if it is the Urologist doing the test, they will want to wait a month or 2 (and that number should be 6 months or a year) and then do a follow up PSA to see if the number goes up, which is what they are looking (or perhaps hoping) for so they can proceed to testing and then biopsy (where the real money starts flowing).
Another personal note, if my primary care physician would have followed these mythical guidelines, I would have been sent away with a “normal” PSA reading. However, my PSA had risen to 4.3 (at 62) so it was a red flag for my PCP and he sent me to a Urologist to get me on the hamster wheel. I wish I would have known then what I know now, but that is why we are here, right?! I am just keeping it real with the personal aside to once again prove that I have lived this nightmare and am not just blowing smoke up your skirt!
I think the above is very interesting because every credible web site and scientific organization readily acknowledges that there is no such thing as normal for a PSA test. If that is true, then why do they waste the time telling us what is normal by decade of life?? Even more interesting is that they have printed guidelines and then no doctors follow those guidelines and stick to 4.0 regardless of a man’s age when being tested. It is kind of maddening or sickening; I am not sure which is accurate.
As is obvious, this all leaves me very conflicted. Is Doctor Ablin correct when he says a PSA test is not a good way to measure if a man has Prostate cancer, or do we accept the common explanation and the FDA who has approved PSA tests as “early diagnostic” tools for Prostate cancer. Again, using me as an example, what would have happened if I did not follow my PCP’s advice and NOT do the follow up with a Urologist? Would it have been a fatal mistake or perhaps changed my diagnosis a year later from a Stage 2 Prostate cancer to a Stage 3 or 4 Prostate cancer? I have no idea but have done enough research to know that what probably would have happened is when I did my next yearly physical, in 2024, I would have probably had a higher PSA number (mine peaked at 6.5 with the Urologist before we began Radiation). That would have certainly spurred a push to the Urologist’s office, which would have put me on the treadmill, just a year later.
The last word on PSA and a PSA test is actually very simple. The PSA test for a man at any age is used as a simple diagnostic tool to determine if a man is “normal” or if he needs to undergo further testing to determine if he has Prostate cancer. That is really the bottom line and a lot of hubris to make a determination of where to go next.
The natural alternative to the above would be to just go to biopsy for any man over 60, since the statistics say you already have about a 60-65% chance that you already have Prostate cancer and the question is how aggressive is your cancer? Mine is very slow growing and not as scary! However, I think most of us would revolt if a doctor said you are over 60 so I want to do a biopsy to see if you have Prostate cancer. You may feel a bit of discomfort but it won’t be too bad?! Where is the back door cause I’m out of here!!
In our next discussion we will follow what happens if you have a so-called abnormal PSA. Where do you go from there and what is the system to measure Prostate cancer if I have it? This will take us to a discussion of Gleason Scores and next stage diagnostic tools including the biopsy!!
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