, the separation between benign enlargement and prostate cancer are increased and therefore unnecessary biopsies can be reduced with the help of age-related PSA threshold values, the respect of the free PSA level (tPSA), PSA density and PSA increase speed.
A. Age-related PSA values \u200b\u200b
This can reduce unnecessary biopsies and discover potentially aggressive tumors in young patients, in addition:
- < 50 Lebensjahr: < 2,5 ng/ml
- 50-59 years: < 3,5 ng/ml
- 60-69 years: < 4,5 ng/ml
- 70-79 years: The use of < 6,5 ng/ml
age-based limits is controversial.
B. Free PSA concentration (fPSA)
The fPSA is used to the sensitivity of PSA for screening in the range of 2-4 ng / ml to increase. Furthermore, with the fPSA specificity of PSA in the range of 4-10 ng / be improved ml.
studies have shown that a high free PSA in the gray area rather than for a benign enlargement of prostate cancer (prostate cancer) is talking about. On the other hand, speaks a lower share of a developing prostate cancer, which should be further clarified or verified.
The following examples illustrate how difficult is the assessment of these values:
- if the t-PSA in the normal range of less than 4 ng / ml and f-PSA-percent value is low at 9 percent, so the values \u200b\u200bare very suspicious for cancer.
- Is the t-PSA level above 10 ng / ml increased and is found while a high f-PSA-percent value greater than 21 percent, is so most probably not cancer.
C. PSA density (PSA D ensity)
The PSA density (prostate volume ratio) to avoid unnecessary prostate biopsies in the course. It is a calculation of the PSA value to the particular means of TRUS prostate volume:
It is used in patients with benign prostate enlargement and PSA levels of 4-10 ng / ml. In a PSA density less than 0.15 a carcinoma is unlikely. In contrast, the probability of prostate cancer rises from a prostate volume ratio of 0.15. This assessment is scientifically controversial, however.
D. increase in PSA velocity (PSA V elocity)
The increase in PSA velocity can with the help of 3 PSA determinations (be PSA1-3) within 2 time periods (t1-2) calculated from a total of at least 2 years:
is particularly suitable increase in PSA velocity in patients with low PSA levels and for patients after negative biopsy. A rapid rise in blood levels - at the same laboratory tests - over a shorter period may be a warning signal. More specifically, an increase in PSA velocity has more than 0.75 ng / ml / year indicate a prostate cancer. This assessment, however, is also controversial.
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