|
ng/ml
|
||
|
months
|
||
|
%
|
||
| ng/year (increase) |
|
|
||
| ml | ||
| ml |
| umol/L | ||
| ml/min/1.73m2 | ||
| mU/L | ||
| nmol/day | ||
| umU/L | ||
| nmol/L | ||
| IU/L | ||
| IU/L |
| Fasting | ||
| mmol/L | ||
| mmol/L | ||
| mmol/L | ||
| mmol/L | ||
| mmol/L | ||
| % | ||
| PSA: age-specific normal reference ranges | |
|---|---|
| Age (years) | PSA range (mg/ml) |
| 40-49 | 0-2.5 |
| 50-59 | 0-3.5 |
| 60-69 | 0-4.5 |
| 70-79 | 0-6.5 |
Ref: John Tuckey's NZ Doctor article, table 2
Please refer to sections 5.1 to 5.8 inclusive for information on PSA kinetics.
PSA Velocity is the change in PSA over time. The more rapid the change, the more likely cancer is present and the cancer could be an aggressive form. Velocity is of limited use without graphical presentation.
The Gleason grading system for Prostate cancer is based on the microscopic properties of the cancer cells, scores range from 2 to 10 and indicate how likely a cancer will spread, a low score indicates that the cancer tissues is similar to normal Prostate tissue and it is unlikely the tumour will spread. A high score indicates the cancer is very different from normal Prostate tissue and is likely to spread. The terms Gleason score and Gleason sum mean the same. For more information see the Library, sections 8.0 and we suggest you also read sections 6.0, 7.0 and 9.0 - this outlines the decision to proceed to Prostate biopsy.
Differential Diagnosis of raised PSA: Prostatitis (acute and chronic) - often rapid rise to 30 ng/ml; BPH - moderate slow rise over time, unlikely above 10; Prostate Cancer - the higher the more likely: 4-10 = 40% chance of cancer, .10 = 67% chance of cancer, > 20 suggests metastatic disease. MoH taskforce recommends referral for any level above 4.0 ng/ml, however as your patient is above the age related upper limit we strongly recommend repeat testing and if the raised level is sustained refer for Urological opinion, query Biopsy.
Consider Prostate cancer even if there is a modest increase more than 0.75 ng/ml per year or doubling time is less than 12 months. A rapid sharp rise is more likely infection or inflammation.
PSA made by cancer cells binds more easily to plasma proteins than "normal PSA" does, as a result cancer is more likely if ratio is low (0.25). This test is most useful when the PSA is elevated in the 4 - 10 range.
In practice most scores range from 6 to 9, any score above 6 indicates cancer and scores 7 and above indicate more aggressive cancer. Interpretation and decision regarding further biopsy should be made by a specialist Urologist.