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Finasteride reduces PSA levels to varying degrees in different men, making it difficult to track what the âtrueâ PSA values are over time. Finasteride fails to reduce PSA velocity (increases) in men with high-grade prostate cancer and fails to induce objective responses in men with metastases. Finasterideâs so-called âpreventiveâ effects in the Prostate Cancer Prevention Trial occurred far too early and did not increase much over time.
In order to increase the efficacy of serum PSA interpretation, a number of performance variables are used clinically. These include age-adjusted PSA, density, velocity, and the free-to-complexed PSA ratio. Age Adjusted PSA: Since PSA normally rises with age, age-adjusted thresholds have been described. Benign growth of the prostate that normally occurs with age is the most common cause of PSA elevation. Roughly 70% of patients with an elevated PSA level between 4 and 10 will have a negative prostate biopsy. Conversely, there is no level of PSA at which you can guarantee a patient that they do not have cancer. Moreover, the absolute PSA level does not predict whether or not prostate cancer is harmful.