Is Total PSA 9.5 ng/ml dangerous?

Published Date : 2024-02-03T14:02:06.297Z

Updated Date : 2024-02-03T14:02:06.297+00:00

What is PSA?

Total PSA, also known as Total Prostate Specific Antigen, is a hormone released by the prostate gland into a man's bloodstream. Normally present in very low amounts, elevated levels of this hormone may suggest the presence of diseases, including various types of cancers.

How is PSA measured?

To measure PSA, a small blood sample is drawn using a syringe or needle and is later analyzed by automated analyzers in the laboratory. It's noteworthy that different analyzers may yield slightly varied results. A study observed that the ECLIA technique tended to show higher results than the CMIA technique, with an average difference of 0.8 ug/L. To ensure accurate monitoring, it's important to consistently use one lab and one measurement technique for tracking your PSA levels.

What is the normal range of PSA and how is a PSA of 9.5 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.

Is a PSA of 9.5 dangerous?

A Total PSA level of 9.5 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 9.5 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 9.5?

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.

Benign Prostatic Hyperplasia (BPH)

Enlargement of the prostate gland.

Prostate Biopsy

Recent prostate biopsy can temporarily elevate PSA levels.

Prostate Massage

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

Urinary Retention

Difficulty in emptying the bladder completely.

Catheterization

Use of a catheter for urinary issues.

Vigorous Exercise

Strenuous physical activity can elevate PSA temporarily.

Cystoscopy

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

Hormonal Changes

Fluctuations in hormones can influence PSA levels.

Prostatitis

Inflammation of the prostate.

Trauma or Injury

Physical trauma to the prostate region.

Obesity

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

Urinary Tract Infection (UTI)

Infections in the urinary system.

Can A Digital Rectal Examination (DRE) tell you if a PSA of 9.5 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 9.5?

Any total PSA value above 4 usually warrants further investigation, and as such, your level of 9.5 should be accompanied by a DRE.

How is a Digital Rectal Examination Done?

Your doctor will perform a digital rectal exam by gently placing a lubricated finger into your rectum to feel the prostate, helping to evaluate its health and detect potential concerns.

Is a Digital Rectal Examination painful?

A digital rectal examination is usually not painful, but it may cause a temporary feeling of pressure or mild discomfort for some individuals.

How does the result of a Digital Rectal Examination affect danger with a total PSA of 9.5?

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 9.5
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What was your previous PSA value?

While deciding whether a PSA of 9.5 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.

With a PSA level of 9.5, 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 9.5

Why does prostate volume matter with a PSA of 9.5?

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 9.5 ng/ml

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 9.5?

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 9.5.

Why do Free PSA levels matter with a total PSA of 9.5

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?

Free PSA serves as a useful marker in distinguishing between benign and malignant prostate conditions, complementing the information provided by Total PSA.

How is free PSA measured?

Free PSA levels are determined by assessing the unbound fraction through precise laboratory analysis.

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 9.5.

Family History with a PSA Level of 9.5

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 9.5, knowing your family history could be useful.

References

1. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter
2. Association of PSA variability with prostate cancer development using large-scale medical information data: a retrospective cohort study
3. Serdarevic N, Dabla P, Stanciu AE. Systematic Differences Between Total and Free Prostate-Specific Antigen Immunoassays: Comparison Using Passing and Bablok Regression. Indian J Clin Biochem. 2021 Apr;36(2):151-158. doi: 10.1007/s12291-019-0818-6. Epub 2019 Feb 13. PMID: 33867705; PMCID: PMC7994458.
4. Song ZJ, Qian JK, Yang Y, Wu HX, Wang MY, Jiang SY, Wang FB, Zhang W, Chen R; Chinese Prostate Cancer Consortium. PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium. Asian J Androl. 2021 May-Jun;23(3):300-305. doi: 10.4103/aja.aja_61_20. PMID: 33208562; PMCID: PMC8152427.
5. Normal Ranges of PSA in different ethnicities