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Is Total PSA 9.2 ng/ml dangerous?

Is Total PSA 9.2 ng/ml dangerous?

In this article we discuss what a total PSA level of 9.2 means, together with its grading, causes, and whether it is good, bad or dangerous.
Updated Date : 2024-02-03T14:02:06.297+00:00

Table of Contents

What is PSA?
How is PSA measured?
What is the normal range of PSA and how is a PSA of 9.2 graded?
Is a PSA of 9.2 dangerous?
What are the less dangerous causes of an elevated PSA level of 9.2?
Age
Can A Digital Rectal Examination (DRE) tell you if a PSA of 9.2 is dangerous?
What was your previous PSA value?
With a PSA level of 9.2, what is your Prostate Volume?
What is your PSA density
Why do Free PSA levels matter with a total PSA of 9.2
Family History with a PSA Level of 9.2
References

What is PSA?

Imagine Total PSA, also known as Total Prostate Specific Antigen, as a hormonal message from the prostate gland into the bloodstream. While it's usually present in low amounts, increased levels may suggest the presence of diseases, including different types of cancers.

How is PSA measured?

To measure PSA, a small blood sample is drawn using a syringe or needle, and it is then analyzed by automated analyzers in the laboratory. Different analyzers may produce slightly different results, as evidenced by a study showing higher values with the ECLIA technique compared to the CMIA technique, by an average of 0.8 ug/L. For accurate and consistent monitoring, it is advisable to stick with one laboratory and one measurement technique for tracking your PSA levels.

What is the normal range of PSA and how is a PSA of 9.2 graded?

Normal Ranges of Total PSA levels vary according to age and ethnicity. Various studies have found considerable variation in the normal range depending upon country and ethnicity.
Age Group US Whites Asians - Chinese European - Spanish Asians - Indians
Younger than 40 years No data No data <1.4(Your value is 557% above normal) <0.71(Your value is 1196% above normal)
40-49 years <2.1(Your value is 338% above normal) <2.15(Your value is 328% above normal) <1.7(Your value is 441% above normal) <0.85(Your value is 982% above normal)
50-59 years <3.6(Your value is 156% above normal) <3.20(Your value is 187% above normal) <3.3(Your value is 179% above normal) <1.13(Your value is 714% above normal)
60-69 years <1.3(Your value is 608% above normal) <4.10(Your value is 124% above normal) <5.18(Your value is 78% above normal) <1.45(Your value is 534% above normal)
70-79 years <5.8(Your value is 59% above normal) <5.37(Your value is 71% above normal) No Data <1.84(Your value is 400% above normal)
80 years and older No data No data No data <2.35(Your value is 291% above normal)

Is a PSA of 9.2 dangerous?

A Total PSA level of 9.2 cannot be called 'good'. This is because values >= 4 have typically been designated as the cut-off for futher investigation, monitoring and in some cases - biopsy. Whether a value of 9.2 is to be considered worrying or dangerous depends on various factors as listed below.

What are the less dangerous causes of an elevated PSA level of 9.2?

Cancer is not the only cause of a raised PSA level. An elevated PSA can have various non-cancerous, and hence less dangerous causes. Each of these causes should be evaluated as well.

Hormonal Changes

Fluctuations in hormones can influence PSA levels.

Prostate Massage

Manipulation of the prostate can lead to a temporary PSA increase.

Obesity

Higher body mass index (BMI) may be associated with higher PSA levels.

Catheterization

Use of a catheter for urinary issues.

Post-Radiation Therapy

PSA levels can temporarily rise after radiation treatment.

Trauma or Injury

Physical trauma to the prostate region.

Dehydration

Can cause concentration changes in PSA levels.

Vigorous Exercise

Strenuous physical activity can elevate PSA temporarily.

Cystoscopy

A medical procedure involving the insertion of a tube into the bladder.

Inflammation in the Body

Systemic inflammation can affect PSA levels.

Age

PSA levels naturally tend to increase with age.

Digital Rectal Examination (DRE)

A recent prostate examination may cause a transient rise.

Can A Digital Rectal Examination (DRE) tell you if a PSA of 9.2 is dangerous?

Can A Digital Rectal Examination (DRE) tell you if a PSA of 9.2 is dangerous?

A digital rectal examination is a technique by which a doctor palpates your prostate gland with his/her fingers. Digital Rectal Examination is usually done when you have complaints of an enlarged prostate and its associated symptoms.

Is a digital rectal examination necessary for a PSA level of 9.2?

Any total PSA value above 4 usually warrants further investigation, and as such, your level of 9.2 should be accompanied by a DRE.

How is a Digital Rectal Examination Done?

A prostate exam involves the doctor inserting a lubricated finger into the rectum to assess the prostate's health, identifying any potential issues that may require attention.

Is a Digital Rectal Examination painful?

In general, a digital rectal examination is not considered a painful procedure, but some men may feel a momentary discomfort or pressure.

How does the result of a Digital Rectal Examination affect danger with a total PSA of 9.2?

A digital rectal examination is usually done when investigating patients for prostate health. Research shows that a positive DRE - when the doctor can feel nodules or hardening of your prostate, is associated with a higher risk of cancer. The table below elucidates describes your risk for a PSA of 9.2
.

Digital Rectal Examination - Normal Digital Rectal Examination - Suspicious/Abnormal
Your risk of cancer is 12% - 32% Your risk of cancer is 42% - 72%

What was your previous PSA value?

What was your previous PSA value?

While deciding whether a PSA of 9.2 is dangerous, we need to track how fast it changes over time. An increase in PSA value of more than 20% over a period of 6 months to 2 years, is usually not a good sign.

Why is the change in PSA values over time important?

As per research, a fast increasing PSA values is more likely to be a fast growth, of some kind, which includes the possibility of cancer. Hence tracking the change in the value over time is important.

Over what period of time can the change be tracked?

In various studies, values upto 2 years ago were included while tracking the change in the value. So any previous value of PSA upto 2 years, ago, can be used to track the rate of change.

Should the two values be from the same laboratory?

PSA values can differ significantly depending on the method or technology used to measure them. It is absolutely essential to use the same lab and same method of measurement for serial measurements.

How much has your PSA level changed over time?

Based on research 2, the percentage change in your PSA value over time, has a direct bearing on the probability of cancer. If you have had your PSA done at any time in the past 2 years, the change in the value compared to today, can be very helpful in deciding what to do next. The table below assumes different values for your PSA level in the past and compares them with the present level.

Your previous PSA value What it means
Your previous PSA level was Less than or equal to 7.4 Higher risk of cancer - your PSA has increased by more than or equal to 20%, this is a bad prognostic indicator.
Your previous PSA level was Greater than 7.4 Lower risk of cancer - Your PSA has not increased by at least 20%, and this means it is not rapidly increasing, implying a good prognostic sign.
Greater than or equal to current 9.2 Good sign - your PSA is either stable or reducing.

With a PSA level of 9.2, what is your Prostate Volume?

Prostate volume is measured by your radiologist using an Ultrasound scan or USG. It can also be measured by MRI. Prostate volume can be used to decide whether you are at a greater risk, in the presence of a PSA level of 9.2

Why does prostate volume matter with a PSA of 9.2?

Prostate volume increases in both bening and cancerous growths. The amount of growth differs. In cancers, contrary to what we might expect, the total volume is lower, than in benign conditions.

What is the volume of your prostate?

Prostate volume is usually measured using Ultrasound(USG) or MRI or both. The volume of the prostate is a useful indicator, to tell the difference between normal enlargement and a cancer. This is because, a lower prostate volume, with a higher value of PSA is more likely to harbour a cancer. The table below gives you a summary.

Risk of Cancer with different prostate volumes for PSA levels 9.2 ng/ml
Prostate Volume Risk
3.3 - 24.5 ml Highest Risk
24.5 - 45.7 Higher Risk
45.7 mL - 58.2 ml Hard to predict
45.7ml - 66.9ml Lower Risk
66.9 - 81ml Lower Risk
>81ml Lowest Risk

What is your PSA density

PSA Density is basically your PSA level divided by your prostate volume. It has been proven to be useful in estimating risk associated with PSA levels above 4 ng/ml.

How is prostate density measured?

Prostate density needs both the volume and the level of PSA. So you will need a blood test to measure your PSA level and an ultrasound or MRI to measure the volume of your prostate.

Why does prostate density matter with a PSA of 9.2?

Prostate density attempts to combine the level of PSA and the size of the prostate to eliminate variables associated with both. The ratio can be used to predict prostate cancers.

Do you know your PSA Density?

The PSA density is a ratio calculated by dividing the PSA level by the volume of the prostate. It is often used to decide whether a patient with other suspicious findings should go ahead for a prostatic biopsy. A higher density has been associated with a higher risk of cancer. The table below depicts different PSA densities for your PSA level of 9.2.

Prostate Volume PSA Density Risk
20 0.5 Higher Risk
25 0.4 Higher Risk
30 0.3 Higher Risk
35 0.3 Higher Risk
40 0.2 Higher Risk
45 0.2 Higher Risk
50 0.2 Higher Risk
55 0.2 Higher Risk
60 0.2 Higher Risk
65 0.1 Lower Risk
70 0.1 Lower Risk
75 0.1 Lower Risk
80 0.1 Lower Risk
85 0.1 Lower Risk
90 0.1 Lower Risk
95 0.1 Lower Risk
100 0.1 Lower Risk

Why do Free PSA levels matter with a total PSA of 9.2

Free PSA is a component of the total PSA that has significance in predicting the risk of cancer.

How does free PSA differ from Total PSA?

Total PSA measures both free and complexed forms, while Free PSA selectively evaluates the unbound fraction for prostate cancer assessment.

How is free PSA measured?

A laboratory test is conducted to determine Free PSA levels, isolating the unbound fraction for accurate measurement.

What was the result of your free PSA Level?

Free PSA is a subset of the total PSA measurement. It needs to be measured seperately, and is an independent test. The ratio of free PSA/ total PSA has been shown to help diagnose cancers. A low ratio, or lower percentage of free PSA is associated more commonly with cancers. As such, for values of total PSA between 4 and 10 , the %free PSA, may be useful in determining danger. The following table, estimates different values of %free PSA, for your value of total PSA of 9.2.

Free PSA %Free PSA Risk
0.6 7 Higher Risk
1.1 12 Higher Risk
1.5 16 Higher Risk
1.8 20 Lower Risk
2.3 25 Lower Risk
2.8 30 Lower Risk

Family History with a PSA Level of 9.2

Family history plays an important role in assesing the risk of cancern with PSA levels above 4.

Why is family history important while evaluating PSA?

There is evidence for genetic tendencies for prostate cancer.

Do you have any relatives with Prostate Cancer?

Irrespective of the value of Total PSA, men with at least one first-degree relative, who had prostate cancer, have a 10-15% higher chance of developing prostate cancer. Thus with a total PSA level of 9.2, knowing your family history could be useful.

Dr.Bhargav Raut - Profile Image

Reviewed By -

Dr.Bhargav Raut is a qualified Pathologist, with over 5 years of experience in the field
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