What rate of increase in PSA will trigger a biopsy?
As men age, their PSA levels will typically rise due to progressive enlargement of the prostate gland. Since the normal prostate makes PSA, the PSA level will continue to rise very slowly as the prostate grows. The acceptable rate of increase has been controversial over the years, and it remains unclear. Early investigations based on the Baltimore Longitudinal Study of Aging demonstrated that men whose PSA rose more than 0.75 ng/dl per year were more likely to develop prostate cancer in follow-up. However, because the study was not primarily intended to evaluate risk of prostate cancer, not all men were biopsied. More recent studies of men followed within a prostate cancer screening study suggest that a PSA rise of more than 0.4 ng/dl per year may be suggestive of cancer (Loeb S, Roehl KA, Catalona WJ, Nadler RB. J. Urol. 177(3):899-902 (2007); Loeb S, Roehl KA, Nadler RB, Yu X, Catalona WJ. J. Urol. 178(6):2348-52 (2007); Taneja SS. Eur. Urol. 52(2):607 (2007)).
