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PSA level is one of three variables on which the risk stratification is based; the others are the grade of prostate cancer (Gleason grading system) and the stage of cancer based on physical examination and imaging studies. D'Amico criteria for each risk category are: [17] Low risk: PSA < 10, Gleason score ≤ 6, AND clinical stage ≤ T2a
[10] However, problematic aspects of the original Gleason grading system still characterize the 2005 revision. The predominant lowest score assigned is Gleason 3+3 = 6. Patients who are told their Gleason score is 6 out of 10 may interpret that they have a more aggressive intermediate cancer and experience greater anxiety. [11]
Of note, this system of describing tumors as "well-", "moderately-", and "poorly-" differentiated based on Gleason score of 2–4, 5–6, and 7–10, respectively, persists in SEER and other databases but is generally outdated. In recent years pathologists rarely assign a tumor a grade less than 3, particularly in biopsy tissue.
A PSA of 4 nanograms per milliliter (ng/mL) is typically the cutoff that doctors use to recommend more testing, according to the American Cancer Society. If your levels are between 4 ng/mL and 10 ...
The PSA era Prostate Cancer Intervention versus Observation Trial (PIVOT), compared radical prostatectomy to watchful waiting among 731 men (mean age 67 years) with localized prostate cancer. [10] At 12 years, a subset of men with a PSA above 10 ng/ml and those with intermediate to high risk disease had a reduction in prostate cancer death with ...
Those with elevated PSA may undergo secondary screening blood tests that measure subtypes of PSA and other molecules to better predict the likelihood that a person will develop aggressive prostate cancer. Many measure "free PSA" – the fraction of PSA unbound to other blood proteins, usually around 10% to 30%.
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