How Long Will My Follow
You will have follow-up appointments for some time after your treatment. Exactly how long will depend on your cancer, any side effects of treatment and the services in your area. You will usually have appointments for several years.
After your follow-up appointments finish, you may continue to have PSA tests. Speak to your GP if you have any problems or concerns they can refer you back to the hospital. Make sure you remind them about your prostate cancer, especially if its been a while since you had treatment or a PSA test.
What Should You Know About Psa Levels
Under normal circumstances, the serum secretions of PSA should stay under 4 nanograms per milliliter . People who have prostate malignancy usually have high PSA levels, but low or normal PSA doesnt always mean that the person is cancer-free. A smaller number of men with prostate cancer have low or normal PSA levels. This suggests that PSA test by itself is not a confirmatory test but can help in identifying who might be at risk of developing the cancer or has developed the malignancy.
Usually PSA test is preceded or coupled by DRE , in which the examiner inserts the finger in patients rectum to check for the consistency or edges of prostate gland. At risk patients with abnormal findings on the DRE and high PSA levels are subjected to biopsy to ascertain the cause and confirm the diagnosis. It is imperative to mention that False-Positives are common.
High PSA Levels without Prostate Cancer:
Testing errors such as mishandling of sample, measuring inconsistency, lifestyle choices and overall physical health can alter with PSA levels. Following are some physiological causes of high PSA levels.
An Increased Psa Level
A biochemical relapse is when your PSA level rises after having treatment that aims to cure your cancer.
You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA rises quickly or stabilises. You might have a scan if your PSA rises quickly.
The choice about whether to have treatment and what treatment to have will depend on:
- the treatment you have already had
- your general health
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How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.
Why Is Psa Testing Important After Prostatectomy
A doctor may recommend PSA testing to determine if the prostate cancer has returned after surgery.
It is possible for prostate cancer to return after a prostatectomy. One study from 2013 suggests that prostate cancer recurs in around 2040 percent of men within 10 years of having a radical prostatectomy.
Although surgeons remove the prostate gland during a prostatectomy, some cancer cells can travel into the surrounding tissue. If these cancer cells multiply, they can cause prostate cancer to return.
PSA testing can help doctors find and treat prostate cancer early. This is why they offer PSA testing, along with other tests, to people after they have treatment for prostate cancer.
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Table : Predictors Of Biochemical Recurrence At Time Of Diagnosis
Although a number of clinical factors contribute to your risk of relapse after treatment, the parameters below provide a simpler assessment of your chances of biochemical recurrence, based on your clinical profile at the time of diagnosis. For more sophisticated estimates, based on specific risk factors, see Figures 1 through 3.
Low risk Gleason score less than or equal to 6and Cancer stage T2c or more
S Used In Best Practice Statement Development
The AUA convened a multidisciplinary panel for the purpose of developing a resource about PSA testing for urologists and primary care physicians. Panel membership included six urologists, one radiation oncologist, two medical oncologists, one internist and one epidemiologist. Funding in support of panel activities was provided by the AUA. Panel members received no remuneration for their efforts, and each member provided conflict of interest disclosure.
The Panel formulated its policy statements and recommendations by consensus, based on a review of the literature and the Panel members’ own expert opinions. The current policy was based on a reassessment of the previous policy published in 2000. After Panel members agreed on the general areas to be covered, each member took on the task of conceptualizing and writing and/or revising a section of the document in an area where he/she had specific expertise. Every part of the document was thoroughly critiqued by Panel members, both in written comments and in verbal discussions in a series of conference calls. Over the course of successive manuscript revisions, the Panel scrutinized and modified the conceptual framework, reworked the wording of key statements, and reexamined supporting evidence reported in the literature until Panel members reached consensus.
What Other Tests Do I Need
After prostatectomy, youll probably have a PSA test in about six weeks or so. Your doctor will recommend a follow-up schedule, usually every three months for two years. Depending on the results, you may need to test once or twice a year thereafter. Testing may be more frequent if it appears to be rising.
If your PSA levels are high and you have symptoms such as bone pain, imaging tests can be used to determine if cancer has spread. These may include bone scans and CT scans. If a mass is found, a biopsy can determine if its cancerous.
You might not need treatment right away. If youve had multiple PSA tests and it appears that your PSA level is rising, a number of other factors determine the next steps. These factors include:
- age and life expectancy
- if cancer has spread and where
- previous treatments
Radiation therapy after prostatectomy, also known as salvage radiotherapy, can be quite effective after a prostatectomy. External beam radiation can be delivered directly to the area around where the prostate was. The goal is to destroy prostate cells that may have been left behind after surgery. This lowers the risk of recurrence and metastasis, or of the cancer spreading.
Metastatic prostate cancer may not be curable, but there are treatments to slow progression and manage symptoms. Treatments may include:
Ejaculation Is A Potential Cause Of Mildly Elevated Psa
Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam, says Milner. These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days.
To avoid this type of elevation, doctors will usually draw blood for a persons PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.
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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.
Side Effects Of Treatment
Treatments for prostate cancer can cause side effects, which might carry on after your treatment has finished. Some side effects can even start several months or years after treatment finishes.
Side effects will affect each man differently you may not get all the possible side effects from your treatment.
Read more about:
Managing side effects
Side effects can affect your day-to-day life, but there are treatments for them, as well as things you can do to manage them yourself. Its important to speak to your doctor, nurse or GP about them.
If youre having problems with a side effect, you might have a meeting with your doctor or nurse to work out what support you need. They may refer you to someone who can give you more advice and support.
Read more about managing the side effects of prostate cancer treatment.
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Psa Surveillance After Surgery
We used laboratory files within the VA Corporate Data Warehouse to identify the date and value of PSA tests after surgery. We started the surveillance period 60 days after surgery through 31 December 2012 and defined guideline concordance as receiving at least one PSA test within each 12-month period. Each patient was eligible for at least 4 years of follow-up. Next, we determined the maximum PSA value in the preceding year for each person-year of follow-up.
Lastly, we used administrative and pharmacy claims data to identify salvage radiotherapy or ADT after surgery. We censored patients at receipt of these treatments since our primary objective for this study was to understand surveillance patterns and quality after surgery, but before treatment for recurrence. Patients being treated for recurrence typically follow with medical or radiation oncologists, rather than primary care providers as might happen after surgery. Given the risk of ascertainment bias due to patients receiving salvage treatment outside of the VA, we also performed a sensitivity analysis in which patients were not censored in this fashion. We also censored patients at death.
If Your Prostate Cancer Has Spread
If cancer has spread to other parts of your body it cant be cured. This is advanced prostate cancer. Treatment can help to control the cancer and your symptoms. This might be:
- hormone treatment to lower your testosterone levels
- bisphosphonates to help with bone pain
- radiotherapy to particular parts of the skeleton
- radioactive liquid treatment radiotherapy , such as radium-223
If hormone therapy is no longer working for you, you might have:
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How Your Doctor Monitors You After Treatment
After treatment you have follow up appointments, which usually include regular blood tests to check the levels of a protein called prostate specific antigen . They check to see if your PSA level rises. And they also look at how quickly it rises.
An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in or around the prostate. Or they might have spread to other parts of your body. You might need treatment if it rises.
Prostate cancer that comes back after treatment is called recurrent prostate cancer.
Immediate Radiation When Psa Levels Spike After Prostate Cancer Surgery Helps Reduce Risk Of Recurrence
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Following surgery to remove a cancerous prostate gland, some men experience a biochemical recurrence, meaning that prostate-specific antigen has become detectable in their blood. Since only the prostate releases PSA, removing the gland should drop this protein to undetectable levels in the body. Detecting PSA could signify that prostate cancer cells are lingering, and forming new tumors before they can be seen with modern imaging technology. PSA isnt always reliable for cancer screening, but it is a very sensitive marker of new cancer growth after initial treatment.
Doctors usually treat biochemical recurrence by irradiating the prostate bed, or the area where the gland used to be. Studies have shown that this treatment, which is called salvage radiation, helps to minimize the risk that prostate cancer will return and spread, or metastasize. But when to initiate salvage radiation has been open question, since PSA will also rise if small amounts of benign prostate tissue have been left behind after surgery. Many times, doctors dont know if biochemical recurrence is really cancer, so they wait to see if the PSA levels will rise any further.
In this newer era of ultra-sensitive PSA testing we didnt know if giving salvage radiation at lower levels would make a difference or not, Tendulkar said. Now we know that it does.
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How The Prostate Changes As You Age
Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms arent noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.
Tell your doctor if you have these urinary symptoms:
- Are passing urine more during the day
- Have an urgent need to pass urine
- Have less urine flow
- Feel burning when you pass urine
- Need to get up many times during the night to pass urine
Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation , enlarged prostate , and prostate cancer.
One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.
How To Handle A Relapse After Treatment For Prostate Cancer
Am I going to die? This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen level has risen after he has already undergone treatment for prostate cancer . The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.
Thats usually of small comfort to the patient whose PSA has risen. Its emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, its as if theyre dealing with another diagnosis of cancer, except this time its much worse because there is less likelihood of getting cured. A mans confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.
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Persistent Psa After Radical Prostatectomy How To Interpret The Data
Although PSA should be 0 after surgery, some patients are faced with one of two scenarios: PSA recurrence or PSA persistence.
Since other cells in the body can produce small quantities of PSA, the test would raise no concerns if the PSA is 0.1 after prostatectomy. However, any results higher than this can lead to one of the aforementioned scenarios.
Persistent PSA after radical prostatectomy is the detection of a PSA higher than 0.1 nanograms of PSA per milliliter of blood . The distinction is that the PSA has not recurred, but rather persisted after surgery.
The key difference this small distinction makes is the prediction of the course the disease will take. A persistent PSA after radical prostatectomy or other forms of treatment can, unfortunately, mean cancer has progressed and metastasized. In many cases, the best course of secondary treatment is hormone therapy with the purpose of shrinking the size of cancer tumors.
When Is The First Post
Once patients are undergoing prostate surgery, they need some time to recover. The first PSA test after prostate surgery is usually taken between 1 and 3 months after the procedure. During this interval, the body recovers its vitality and, by this time, the system has already cleansed the body from any remnants of PSA produced by cancer cells.
Therefore, the first PSA test after prostate surgery will show the amount of prostate-specific antigen that the body produced after surgery. If the readings come back as normal, then doctors are going to deem the prostate surgery successful.
However, patients are going to continue to undergo PSA tests once every 6 or 12 months for the following 5 years. In case that, during this interval, all PSA tests show normal readings, then the patient is considered cured.
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