What Is a Normal PSA for a Man Without Prostate Cancer? | Ask a Prostate Expert, Mark Scholz, MD

[Music] all right dr. Scholl's so we're covering the topic of PSA today which is a very vast topic there's multiple facets to it but can you talk about the origins of PSA and also what a normal PSA should be to a man who does not have prostate cancer yeah obviously very controversial and very important we're talking about you know tens of millions of men that are you know 40 or 50 or older that should be doing this blood test once a year just make sure they don't let prostate cancer slip through one patient described the

PSAs as the check engine light blood tests for men because the check engine light people understand that it's not really measuring anything it's just saying hey there's there's a light on you better go to the mechanic it checked out find out what's going on so why would that be controversial we've all heard about people saying bad things about PSA and the reason is is that when you go to the mechanic sometimes the mechanic does work on your car that you don't need and and that's in the prostate cancer world I don't think it's because of

dishonesty per se but I think it has to do with as technology has moved forward over the last 10 15 years it's been hard for the physicians to keep up with how quickly things are changing and historically when you hear the word cast you think action get to surgery save your life from the cancer and that was a reasonable conclusion 15 20 years ago but now we know that there's many types of mild prostate cancer that don't need immediate treatment and the industry is coming around slowly but that's where the controversy lies there's no problem

with the test itself as long as you interpret it as a check engine light and not as something that will tell you yes or no I need treatment that is determined by other factors biopsy results scan results and and thorough study as to what type of prostate cancer you're dealing with right right so when it comes to why is PSA so controversial I mean this is a huge topic but it seems like a lot of urologists we're giving PSA tests and they stopped and now it's kind of coming back the urologist have been pretty steadily

behind PSA throughout this whole time period but the primary care physicians the ones that are performing most of these screening tests have been concerned that their patients have been shuffled into too much treatment and to protect their patients some of them decided it was in their best interest to stop doing PSA testing it's kind of a baby with the bathwater problem you know you yeah you you do spare some men from over treatment but then on the other end of the spectrum you have some men with that cancers that it's getting outside the prostate without

someone detecting it at a curable stage so how much do you think the PSA task force had to do with that situation well they pretty much started this is the the group of government appointed body back in 2012 that came out and said all these negative things they recanted in 2016 and the the PSA was brought back as a viable blood test and if it's used properly so can you discuss you know when it can I get a PSA test they get their results from their primary four you know care physician what should a normal

PSA be for a man who does not have prostate cancer so the usual threshold depending on the lab would be either 4.0 or less would be normal or 2.5 or less would be normal different labs and different PSAs are out there that that's a reasonable threshold to to use as an action point for further intervention it's not a perfect test but when you're screening millions of people you have to set some sort of threshold to take action so what happens if a PSA comes back and it's under one so very low psays of 410 -

very good prognosis men that are under 1 are at very low risk for getting clinically significant prostate cancers people say what I mean normally a normal PSA would be around less than 4 or less than two and a half and why do I say what well it turns out that people can have significant prostate cancer with a PSA of two or three and that means that you can't just blanket statements say if it's under four everything's fine however the the you know you have to draw the line somewhere you are we gonna be doing MRIs

on everybody with a PSA over one no so the other things that are looked at or how big the prostate is how fast the PSA is changing over time and maybe we should address those each individually yeah the so let's look at let's talk about the ratio of how high the PSA is how to how big the prostate is there's this is called PSA density and a normal PSA ratio is about ten to one so if the prostate has been measured with an ultrasound or an MRI and the gland is say 30 CC's 40 CCS

which would be a normal sized prostate the PSA should be around three to four if the gland is really enlarged as is the case for some men as they get older you're looking at sixty eighty or even a hundred CC prostate then those men can have PSAs that are six to eight to ten and still be normal that without any necessary indication that there's underlying cancer so that's a rough rule of thumb and again it doesn't provide enough precision just say for sure there's no cancer but at least it doesn't raise alarm bells for someone

who has a 20 or 30 CC prostate and their PSA is 10 that's a lot different than someone that has a hundred CC prostate in their PSA is ten well when you have like a man who's in that situation which is a common helpline scenario so his PSA let's say is six or seven but then we find out that he has a larger prostate so he finds out he has a large prostate but we can't just roll it out because it's a larger prostate so what's the next steps that he should do and talking to

his doctor well everyone should get a digital rectal exam and then they the sort of stopgap method that we talked about would be to either get a blood test called up go for okay or urine test called select MDX now these tests are useful if they come back with extreme results unfortunately they don't say you do or don't have significant cancer what they do is they say they give you a percentage likelihood that you have significant cancer and that's useful if let's say the percentage likelihood is 4% not very useful if it says it's like

31% so you say well that's that's a risk or if it comes back and says that your risk of significant cancer is 80 or 90% you say okay that's helpful I gotta check this out this is really a concern so that the aapke for K and the Select MDX don't always lead to complete resolution and but when they do I think if you come back with a risk of 4% you say well why don't we just watch this let's get another PSA in six months and and maybe even repeat the OP go for K in

six months and if it's holding steadily at a very favorable range maybe you're done you just keep an eye on it for the men that come back where it's ambiguous then you're on to some sort of a scan we typically recommend you know getting in a multi parametric MRI 3 Tesla multi parametric MRI or color Doppler ultrasound or of course many places like to do random needle biopsies that's been pretty much the standard now for about 30 years I tend to prefer the imaging the non-invasive approach which I has actually been shown to be more

accurate of course not as risky because random biopsies can result in serious infections right and with the MRIs they can get targeted biopsies right so offense if they find a suspicious spot with the scanning that we're talking about then they can do a one or two needle biopsies then the risk of infection will be much lower right right well there's that's a lot to think about for patients so if you guys want to break down you should really see the timestamps in our video descriptions because you can click into each subject and go over that

for for studying later thank you so much for watching if you have questions you would like us to ask our prostate cancer expert you can go ahead and email us at info at PCI org and we have a ton of information on our website as well so go ahead and visit that and if you enjoyed this video please give us a thumbs up and click the subscribe button this helps other prostate cancer patients learn about our channel on the YouTube platform we hope you have a great week you [Music]