> digital rectal exam (DRE)
> PSA Kinetics (velocity, PSAV and doubling time, PSADT)
A PSA increase (velocity) of 0.75 ng/ml/y in a PSA range of 4-10 ng/ml over at least 18 months is considered to be significant.
Determining the PSADT, which is the length of time in months for a PSA to double based upon exponential growth with a shorter (but faster) doubling time having a poorer outlook, may be meaningful. For example, a PSADT of under 2 years should raise suspicion for either the presence of a prostate cancer or a cancer on active surveillance which may be progressing. A long PSA doubling time has a low likelihood of significant impact.
> PSA density
The dPSA is measured by dividing the weight of your prostate into your current PSA.
A dPSA > 0.15 may be significant.
> age-specific PSA ranges
Using tables showing the normal increasing PSA ranges for advancing age.
> evaluating the PSA after a 3-month course of finasteride (proscar)
To see if the PSA drops by about 50% after a 3-month course of finasteride; if so, it is thought that the chances of having a prostate cancer are diminished.
> performing the PCa3 test
This involves a vigorous prostatic massage and an mRNA analysis of the seminal fluid washed out in the initial urine sample after the massage. This test may be useful when the information is combined with the PSA derivatives. On its own, the PCa3 is associated with too many false positive and false negative results to be reliable.
> ultrasensitive PSAs
May be more useful for detecting prostate cancer recurrences after a treatment.
> newer biomarkers
Blood biomarkers like the pro-PSA and others as well as new urinary and tissue biomarkers like the PTEN are still undergoing evaluation. These new biomarkers may predict reliably prostate cancer progression and which cancers truly demand treatment.
> unlike its inaccuracy as a prostate cancer screening marker, the PSA is a reliable indicator of presence or absence of cancer after prostate cancer treatment.
> high-risk or aggressive prostate cancers such as small cell cancers may produce little if any PSA rise, even with prostate cancer progression.
> the upgrading of a residual prostate cancer to a more aggressive prostate cancer may occur after ANY TREATMENT option without a significant rise in PSA. Therefore, PSA monitoring needs to be interpreted very judiciously.