PSA levels alone may not reflect prostate cancer growth

Cornell Chronicle ^ | 07/01/2026 | Heather Lindsey

[TexasKamaAina]

Patients with advanced prostate cancer may need periodic imaging scans to catch tumor growth even with stable levels of prostate-specific antigen (PSA), a protein in the blood that doctors routinely monitor for cancer progression, according to an analysis led by researchers at Weill Cornell Medicine and Duke University. In some cases, cancer progression was detected on scans even when PSA levels were undetectable.

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TOPICS: Health/Medicine
KEYWORDS: prostate; psa

[TexasKamaAina]

This article is about the limits of relying on the PSA test to detect cancer progression in patients who have already been diagnosed and treated for prostate cancer. I'm posting it because I know three men whose doctors relied on the PSA only at their annual physicals but subsequently had a tumor detected with a digital rectal examination (DRE). One of them (my brother) had cancer so advanced that it killed him.

My urologist has expressed his frustration with doctors that do not conduct a DRE. He said that no one likes doing it or receiving it but it, though uncomfortable, is quick, painless, easy and effective.

[dayglored]

I am 74, have BPH, and my PSA runs 5-7 for the last few years. My urologist gets that checked twice a year, and does a DRE every 12 to 18 months.

[PGalt]

Thanks for posting. Condolences. Health / life BUMP.

[Labyrinthos]

He said that no one likes doing it or receiving it but it, though uncomfortable, is quick, painless, easy and effective.

Unless the tumor is on the "dark side of the moon" or middle section of the prostate.

[DIRTYSECRET]

I’ve read about the new Stockholm3 blood test. Supposedly it’s better. My old doctor used to stick something up there. I’ll never know if it was an instrument or his finger because I couldn’t see and I never asked. For awhile I was wondering if he was doing it because he liked it.

[Az Joe]

Sorry about your brother. He didn’t have symptoms until too late? What were they?

[central_va]

My doc gives me a glass of Chablis and a cigarette before.

[aquila48]

“For awhile I was wondering if he was doing it because he liked it.”

It’s even worse news if you like it!

[SomeCallMeTim]

Yes Thanks for the post.

I’ve been wondering….my PSA went up, barely over 4, a year ago. My Doc at that time did not do a manual, but did recommend imaging. It showed a spot, he did a biopsy, and found very low levels of non-aggressive cancer type. Since then, my PSA has decreased to 3. But I do now feel some slight pain at times.

New Doc did a digital test. He says he’s “old school”, and it’s simple and easy enough to justify doing.

We’re monitoring PSA now…. But I’ve wondered if it’s still reliable?

[central_va]

Soft music and dim lighting helps.

[donozark]

Nothing wrong with a glass of wine and a cigarette before. But I draw the line at a reach around. LOL!

[donozark]

VA stopped doing PSA as a routine test. “Unreliable” I was told. Have read similar reports to that effect.

[Labyrinthos]

I am 67. PSA has been above 4.0 since age 50. I have been on a “watch and wait” regiment ever since, with PSA tests 2X per year. Over the last 10 years, I have consistently tested above 10.00 — mostly in the 13 to 17 range. I have had four biopsies and three hi-resolution MRIs. The best they can say is that I have “suspicious area that we need to keep an eye on” and that I have a very large prostate (BPH).

Most recently, my urologist has prescribed both the IsoPSA blood test and MPS2 urine test, both of which predict the likelihood of developing clinically significant prostate cancer over the next few years. My test results show that I have a 20% risk, which is high, but not so high to warrant another biopsy at this time. Watch and wait.

[AppyPappy]

My PSA was so low, it arrived in the mail addressed to Mrs Appypappy

[Sequoyah101]

Several instances in the last few years suggest strongly that MRI confirmation for Prostate Cancer is the gold standard but it seems most urologists do not recognize this and prefer to do the needle biopsy. MRI carves them and the procedure out of the picture. Hmmmm

. PSA remains only an indicator and scarcely a good means for tracking. There are at least two methods of PSA and each gives a different result compared to each other and even for the same method from lab to lab and test to test. This is hardly a recommendation for use as a progress of cancer tracking means. LIkewise of DRE, it is merely a step up from indications given by PSA and to be followed by more definitive means such as the MRI or needle biopsy. DRE is only subjective at the hand of the examiner and can’t be repeated with precision, there is no precision involved. On that matter, needle biopsy is not the gold standard either as it can simply miss the tumor if it is small.

If my time comes for this I will seek out the MRI. Meanwhile I will continue my annual PSA and respond to that as indicated.

My Dad died of prostate cancer and neglect. Maybe I will find out why someday.