PSA Result Question

ijuanabhappy, ASN, RN · Jun 13, 2008

I am not a nurse yet, but the only little tid bit I have for you (because all I do all day is type medical transcription for urologists), is that if a patient takes a drug such as Avodart then his PSA will be falsely lowered. Therefore when patients are taking some medications such as these, the physician has to "double" the PSA value to get the true result. I know BPH can cause elevations in PSA and usually something like doxycycline is given and then they retest PSA. All of the ranges of values though is very complicated and I am not sure. A nurse should be able to answer that for you.

pagandeva2000, LPN · Jun 13, 2008

I do appreciate what you shared! Thanks!!

Dawn, RN · Jun 13, 2008

We were taught (recent grad.) that normal PSA is less that 4. It is slightly elevated with BPH, prostatitis and prostatic infarction. At a level of 10, they worry about prostate CA but it is not definitive and a DRE should be done too.

Hope this helps and if it is wrong, someone please correct me as this is how I was taught.

MikeyJ, RN · Jun 13, 2008

I just read an article recently (I will try finding it again) that the PSA should probably not even be done anymore because it is very unreliable.

There are a few different medications and herbal medications that create false-positives as well.

pagandeva2000, LPN · Jun 14, 2008

Thanks everyone for the current responses!

DLS_PMHNP, MSN, RN, NP · Jun 14, 2008

It's also important to monitor it (make sure it doesn't double) over the long run.

For example, a PSA of 0.2 that doubles in 6 months to 0.4 is suspicious for cancer.

The worst I have ever seen is a PSA that was over 1500. The pt had metastatic disease EVERYWHERE....

pagandeva2000, LPN · Jun 14, 2008

It's also important to monitor it (make sure it doesn't double) over the long run.
For example, a PSA of 0.2 that doubles in 6 months to 0.4 is suspicious for cancer.
The worst I have ever seen is a PSA that was over 1500. The pt had metastatic disease EVERYWHERE....

OMG 1500!!! I never knew it can even get that high! Are you saying that an initial reading of 0.2 (which, to me, would indicate that this is a negative result) doubles within about 6 months is suspicious of cancer? Or that an elevation of 0.2 on a previous positive reading would need monitoring in the next six months, and if it doubled to the 0.4, there is an increased need to be concerned? If you get a moment, please clarify.

Thank you so much for sharing that piece of information! :yeah:

DLS_PMHNP, MSN, RN, NP · Jun 14, 2008

OMG 1500!!! I never knew it can even get that high! Are you saying that an initial reading of 0.2 (which, to me, would indicate that this is a negative result) doubles within about 6 months is suspicious of cancer? Or that an elevation of 0.2 on a previous positive reading would need monitoring in the next six months, and if it doubled to the 0.4, there is an increased need to be concerned? If you get a moment, please clarify.
Thank you so much for sharing that piece of information!

Basically when PSA is checked each year it should be compared to previous PSAs. Anything that doubles (regardless of how low the original reading is) should be monitored closely.

That patient I mentioned, his PSA was over 1500 when he was diagnosed. He had metastatic prostate cancer in just about every bone and his bone marrow consisted mostly of metastatic prostate cells.. After some hormone treatments, his PSA was only 'down' to 125.... Poor guy! He was also Hep B positive and HIV positive (I think).

Hope this helps.

Best,

Diane

pagandeva2000, LPN · Jun 14, 2008

Basically when PSA is checked each year it should be compared to previous PSAs. Anything that doubles (regardless of how low the original reading is) should be monitored closely.
That patient I mentioned, his PSA was over 1500 when he was diagnosed. He had metastatic prostate cancer in just about every bone and his bone marrow consisted mostly of metastatic prostate cells.. After some hormone treatments, his PSA was only 'down' to 125.... Poor guy! He was also Hep B positive and HIV positive (I think).
Hope this helps.
Best,
Diane

This has helped more than you'll ever know. I think I gave great teaching today based on the information I received on this thread. I didn't learn that in school, and didn't have an occasion to investigate such information until just now. Thank you, everyone!

LovingNurse, BSN, RN · Jun 15, 2008

I know your health fair is over, but wanted to pop in on the topic of PSA screening. I am an advocate for the screening. My FIL developed PCa in his 70s... (PSA of 11 & 12) fairly typical scenario. Sometimes it is a slow-growing cancer, and the older gentleman might die "with" prostate cancer, but not necessarily "from" prostate cancer, but that isn't always the case and the patient deserves the right to know the diagnosis and make decisions. My DH's uncle also had prostate cancer. His was aggressive and metastatic, and he opted to have an orchiectomy to rid his body of the testosterone that was fueling it. With such a family history, I wanted my DH screened starting at age 40.

DH's PSA's were always reported as "WNL" --- UNTIL he applied for life insurance. Life ins. labwork showed his PSA at 4.5, so they ran a "free PSA" which (unlike the regular PSA) should be HIGH. PSA that is "free" is usually more indicative of BPH. When the regular PSA is elevated, but the free PSA is low - it's a bad sign, indicating the PSA may be busy being bound to proteins of a cancerous process.

I am so glad someone brought up that it's the trend of the PSA rising (velocity) that is sometimes more important than just the number! When educating your patients, please teach them to ASK for a copy of their results (or write down the result and the lab's parameters) and know what it is from year to year so they can watch for a rise themselves.

The number doesn't necessarily have to be doubling to be a red flag, so I'd probably leave that part out of the teaching and just say if it's going up, to see a urologist

We saw our GP when my DH was denied insurance for his elevated PSA, low free PSA. --- (BTW, the GP had never even heard of the free PSA, nor was he aware the trend was an issue if it was still under 4.0) We went to urologist and he confirmed the DRE showed the prostate normal size (no BPH) so they wanted to treat him for an asymptomatic prostatitis for a month and repeat the results. The PSA waxed and waned each time, but the free PSA kept dropping.

A PSA above 4 needs investigated, or PSA's under 4 that are rising.

If that's high or rising, the free PSA might help be more specific... Free PSA above 25% is usually more suggestive of BPH.

Free PSA of 15% or lower is more suggestive of cancer.

The highest my DH's PSA got was 5.4, but his Free dropped to only 5% - and that's when they FINALLY did the biopsy and confirmed his cancer. BTW, he was only 49 and this was NOT something he/we ever imagined to be dealing with at that age.

How an elevated PSA & or prostate cancer are treated can be very different for the younger-middle aged men than it is for the older man.

Not all prostate cancers are slow growing. When they do have mets it is often to the bone and a very painful death. I have a friend who's DH was dx at 43 y.o. already with mets, so too late for surgery... it's not just an old man's disease.

Does the PSA cause unnecessary worry for some? Yes. But sometimes it's the only thing that would ever get them to the urologist in time to do something about it. My dad's a senior and probably wouldn't bother with it at his age, but the PSA saved my husband's life, so I can't help but be very, very grateful for it's use.

Sorry for the long post!!!

:heartbeat(((Hugs))):heartbeat

pagandeva2000, LPN · Jun 15, 2008

LovingNurse, I certainly appreciate your contribution to this, because we will be doing health fairs all summer and this will come up again and again. I was only educated to know that 5 and above is suspicious and that is all. Also, I don't work in Urology, where I would be hearing more about it from the practitioners, so, any bit of information I can obtain to educate patients is my main goal.

Now, I am a bit confused about the difference between the free PSA and the 'standard' (don't know what else to call it). You're saying that if the free PSA is 15% or lower, it is suspicious of cancer. I never heard of this test. Would you share a bit more with us about that? I'm a bit thrown at 15% or lower (I am thinking it would be higher) being suspicious of cancer. Thank you so much!

In the meantime, until I know a bit better, I'll explain to patients that 4 or lower is okay, unless it is creeping up, that a person should obtain a copy of the test results and continue to monitor their results on a yearly basis, because even with it being at a 2, if it elevates to 3, it should be further investigated. If I am correct thus far (or not), please let me know. I want to educate them properly, since this is a common screening we do for our health fairs. I have to also investigate how this is followed up after we perform the service. Because this is a hospital that services the poor, I'd like to know if this is followed up by other nurses.