Radical Prostatectomy: Conclusions And Recommendations
When faced with an initial detectable PSA after radical prostatectomy, repeat evaluation of serum PSA is warranted to rule out laboratory error. If, on repeat testing, the serum PSA remains in the detectable range, our initial evaluation would consist of a thorough history and digital rectal examination. We do not routinely perform biopsy of the vesicourethral anastomosis due to both the lack of beneficial information obtained and the potential morbidity of the procedure itself.
In men felt to be at risk for distant recurrence based on either pathologic features or PSA kinetics, a radiographic evaluation for early signs of metastatic disease is warranted. Although there is a low probability of finding significant disease in men with PSA levels under 10 ng/mL, we feel that these studies function as an initial baseline study with which to compare subsequent studies. These studies are then repeated on an annual basis in the asymptomatic patient or earlier if there are signs or symptoms suggestive of distant disease. Unless the patient is being considered for possible adjuvant local therapy, cross-sectional imaging of the abdomen and/or pelvis is not routinely performed.
Psa After Prostatectomy How Important Is It
The PSA after prostatectomy is very important. A major milestone in prostate cancer treatment is obtaining your PSA level close to zero after surgery. The expected result after prostatectomy is an undetectable PSA or 0 PSA level. The surgery itself is a cornerstone of a mans life, but the tests that follow, especially the PSA test, can be very dreaded.
The PSA test is a blood analysis that checks for the level of the prostate-specific antigen in the blood cells. The PSA is an enzyme secreted only by the prostate cells. When the post-prostatectomy PSA level is zero or close to zero after radical prostatectomy, the patient is reassured that he is cancer-free and can regain peace of mind. In the majority of cases, this is the scenario. There are also rare cases when the follow-up tests reveal rising PSA after prostatectomy. What to do if this is your case?
Why You Have The Test
The goal of a prostatectomy is to remove all the cancer, or as much of it as possible. If your cancer hasn’t spread, it might cure you.
But no surgery is perfect. It’s possible that some of the cancer cells spread outside your prostate before your procedure. Or the operation might have left a few cancer cells behind. Those cells could start to grow in the future.
A regular PSA test after a prostatectomy is a way for your doctor to keep tabs on your treatment. It can help your doctor see how well your surgery worked, and if your cancer has come back.
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Elevated Psa Levels After Surgery May Be Suppressed By Radiation Therapy
Radiation therapy for persons who have elevated prostate-specific antigen levels after surgery appears, in many cases, to result in the suppression of PSA levels for 5 or more years. This finding, from researchers in Minnesota, is important because an elevated PSA level is 1 of the most important indications that previous treatment may not have succeeded entirely and more treatment is needed.
Cancer of the prostate, a male sex gland located near the bladder and rectum, is a type of cancer that occurs commonly in older men. One test that may be performed to help indicate whether prostate cancer is suspected is a blood test for PSA, a protein produced by the prostate cells. If PSA levels are high, prostate cancer is more likely, and further tests are needed for diagnosis. Once prostate cancer is diagnosed, doctors must determine the stage and grade of the cancer. Doctors often use a system called the Gleason score to indicate the grade of disease, with a higher score indicating the likelihood of faster growth.
Tips To Get The Most From Your Follow
Write down any questions or concerns beforehand
It’s easy to forget what you want to say once youre at your appointment.
Bring someone with you
It can be hard to take everything in at your appointments. Some people find it helpful to take someone with them, to listen and discuss things with later. If your appointment is on the phone, you could ask a friend or family member to listen with you.
Make notes
It can help to write things down during or after your appointment. Theres space for this in the appointment diary in our booklet, Follow-up after prostate cancer treatment: What happens next?
Ask to record your appointment
You could do this using your phone or another recording device. You have the right to record your appointment if you want to because its your personal data. But let your doctor or nurse know if you are recording them.
Ask for help
If there is anything bothering you, let your doctor or nurse know.
Ask for copies of any letters
If your appointment is at the hospital, ask for a copy of the letter that is sent to your GP. This will happen automatically at some hospitals. It will help to remind you of what was said at your appointment. If you don’t understand the letter, call your main contact at the hospital or contact our Specialist Nurses.
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Does My Psa Level Determine Whether I Have Prostate Cancer
Your provider looks at two factors related to your PSA:
- Your PSA level: A higher level means a higher risk of prostate cancer.
- A continuous rise: PSA levels that continue to rise after two or more tests may mean you have cancer.
But the PSA level alone doesnt determine if you have cancer or not. Two men can even have the same PSA levels but different risks of prostate cancer. And a high PSA level may reflect prostate problems that arent cancer.
Redefining The Role Of Psa After Prostate Cancer Removal
One of the most well-knownand controversialmethods of cancer detection is the PSA test. PSA stands for prostate-specific antigen, the marker in blood that can indicate the presence of prostate cancer.
The PSA test was developed at Roswell Park Comprehensive Cancer Center in the 1970s and was initially intended to check for returning prostate cancer in men who had already undergone treatment. Later, many doctors began using it in healthy men to screen for an initial diagnosis. It has helped diagnose millions of men across the world and saved countless lives.
But in recent years, the usage of the PSA test has undergone scrutiny, with some saying it can lead to over diagnosis or unnecessary treatment. A recent study completed at Roswell Park is helping redefine how we use the PSA test by demonstrating that even when PSA is present, the levels of the marker can be a key indicator of what treatment is necessaryor unnecessary.
After a patient is diagnosed and his prostate is removed surgically, the PSA test is used to see if any cancer remains. About 30 percent of men in this situation will have detectable PSA in their blood. The standard course of treatment has been to have men with any detectable PSA undergo radiation therapy. However, for some men, radiation may not be needed.
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Post Prostatectomy: What Do Rising Psa Levels Mean
New to group! Wish I had checked this out 2 years ago while supporting my husband! Now over e years post prostatectomy, wondering what might make psa go from all 0 to 2.6
Welcome to the Prostate Cancer group, @hoard.You ask a good question. What can rising PSA levels means years after having had a prostatectomy?There are several reasons why oneâs PSA level may rise after being stable for a time. This article explains it well: PSA levels after prostatectomy
Hereâs an excerpt from the article:âSeeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.
In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include: older age ethnicity medicationA doctor will take these factors and the personâs medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern.â
Thank you! Relieves my mind somewhat! Next PSA in November.. long wait.
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During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
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Psa Recurrence After Prostatectomy
Unlike PSA persistence, PSA recurrence is characterized by a PSA of 0 postoperative and a rising in the blood test after an unspecified period of time. Traditionally, the value of 0.2 PSA after prostatectomy has been used as the benchmark to indicate PSA recurrence.
This indicates that a level of PSA lower than 0.2 should not be considered worrisome. Instead, it should be monitored frequently.
How Long Will I Have To Take Hormone Therapy
With intermittent hormone therapy, the LHRH agonist is used for 612 months, during which time a low PSA level is maintained. The drug is stopped until the PSA rises to a predetermined level, at which point the drug is restarted. During the drug holidays in between cycles, sexual function and other important quality of life measures might return. However, the clinical benefits of this approach remain unclear, and large clinical trials are currently underway to evaluate its use in this setting.
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The Risk Of Your Cancer Coming Back
For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.
One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.
Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.
When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.
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Talking With Your Doctor
Different kinds of doctors and other health care professionals manage prostate health. They can help you find the best care, answer your questions, and address your concerns. These health care professionals include:
- Family doctors and internists
- Physician assistants and nurse practitioners
- Urologists, who are experts in diseases of the urinary tract system and the male reproductive system
- Urologic oncologists, who are experts in treating cancers of the urinary system and the male reproductive system
- Radiation oncologists, who use radiation therapy to treat cancer
- Medical oncologists, who treat cancer with medications such as hormone treatments and chemotherapy
- Pathologists, who identify diseases by studying cells and tissues under a microscope
View these professionals as your partnersâexpert advisors and helpers in your health care. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect.
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What Is Psa And How Do Psa Tests Work
The prostate is a small, apricot sized gland that sits below the bladder in males and uniquely produces prostate-specific antigen, a protein that circulates in the bloodstream. A PSA test is a blood test that measures prostate activity, reporting results as nanograms of PSA per milliliter of blood . Prostate cancer screening is generally recommended for men 55-70 years old or as young as 40 years old for men with a family or racial history that places them in a high-risk group. To benefit from prostate cancer screening, a man should be generally be healthy enough to have a 10-year life expectancy.
The range generally accepted as a normal PSA level spans from zero to four nanograms of PSA per milliliter of blood, though there are exceptions based on age, race, and risk factors. You and your physician can discuss whether any such nuanced situations apply to you. Keep in mind although a PSA test can certainly detect high levels of PSA in the blood, it is not enough to diagnose a cancer because an elevated PSA is not a definitive sign of prostate cancer.
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Results Side Effects And What’s Next
According to their results, the more intensive treatments led to better outcomes. Just over 70% of men in group 1 were still avoiding disease progression after five years, compared with 80.3% of men in group 2 and 87.4% of men in group 3. More specifically, 145 of the men in group 1 developed further PSA elevations during the follow-up period, compared with 104 men in group 2 and 83 men in group 3. Similar trends were observed with respect to how many men developed metastases, or cancer that becomes resistant to hormonal therapy after it begins to spread.
The more intensive treatments also had more short-term side effects, especially diarrhea. But differences in side effects between the three groups disappeared after three months.
The authors emphasized that longer follow-up is still needed to confirm whether adding ADT and pelvic node radiation to PBRT actually lengthens survival. Moreover, the study did not evaluate a newer therapeutic strategy for biochemical relapse, where doctors use novel imaging methods to find exceedingly small metastases throughout the body that they treat directly with radiation.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
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Dr Roach: After Prostate Removal Where Does Psa Come From
Dear Dr. Roach: Some 20 years ago, as I was turning 50, a biopsy confirmed prostate cancer. I elected to deal with that through surgery, a radical perineal prostatectomy. For the following 10 years, follow-up blood tests came back showing PSA at less than 0.1, which I interpreted to mean levels below the detectable limit. About 10 years ago the lab announced that they had improved their methods and would henceforth report PSA in blood as low as 0.01. Since then, my lab reports for PSA have been in the 0.02-0.04 range. Are there tissues that are not removed during a radical prostatectomy that could produce these low levels of PSA? Or are these some fugitive prostate cancer cells lurking somewhere?
D.A.S.
Dear D.A.S.: The term prostate-specific antigen isnt exactly correct, because there are other cells in the body that produce PSA at very low levels. Urethral glands can, and so can salivary glands, normal breast tissue and some cancers besides prostate. The parallel structures to the prostate gland in women, Skenes glands, may produce PSA, but not enough to register on a blood test.
Dear Dr. Roach: In 1976 I lost a lung to cancer. I have enjoyed my life and never had a problem. Recently, I fell on the golf course, and landed on my chest on the good lung side. When I hit the ground, I heard a loud crack. I had an X-ray that day, and was so happy the X-ray showed no broken bones. It did show two or three calcium spots in the remaining lung.
S.C.A.
How Important Is The Psa Test After Prostatectomy
The answer is: very . A major milestone in prostate cancer treatment is obtaining your PSA level close to zero after surgery. The expected result after prostatectomy is an undetectable PSA or level of 0. The surgery itself is a cornerstone of a mans life, but the tests that follow, especially the PSA test, can be very dreaded.
The PSA test is a blood analysis that checks for the level of the prostate-specific antigen in the blood cells. The PSA is an enzyme secreted only by the prostate cells. When the PSA level is zero or close to zero after radical prostatectomy, the patient is reassured that he is cancer-free and can regain peace of mind. In the majority of cases, this is the scenario. There are also rare cases when the follow-up tests reveal an elevated PSA after prostatectomy. What to do if this is your case?
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What Is A Psa Test For Prostate Cancer
First of all, lets clarify what exactly is a test based on prostate-specific antigen. PSA is a common type of protein. However, whats unusual about it is that it is produced by both benign and malignant organisms, such as the prostate gland and cancer cells.
A PSA test is used to measure the amount of prostate-specific antigen. There are already set milestones for normal readings at any age. Any increase in PSA levels above the usual threshold may indicate that theres something else producing the PSA protein, and the first assumption falls on prostate cancer cells.
High levels of PSA are not necessarily indicative of prostate cancer. The test is merely triggering some red flags for doctors to further investigate the presence of a prostate tumor. Since an official confirmation of prostate cancer comes in the shape of prostate biopsy, an extremely invasive procedure, it is only sensible to start the prostate cancer screening with a lesser harmful method, namely a PSA test.
Doctors only need a blood sample that they extract from the arm to measure the amount of prostate-specific antigen. This course of action has been approved by the FDA since 1986. Besides prostate cancer, the abnormal readings of a PSA test might also indicate other benign conditions, such as an enlarged prostate or prostate inflammation.