What If A Screening Test Shows An Elevated Psa Level
If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
What Does It Mean
In greatest series about BCR after RP there was no man with local or distant clinical disease without an increase in PSA at the time of progression. Rising PSA is the first sign of disease progression after RP, however it does not necessarily lead men to metastatic disease or cancer mortality in few years . This is the key to understand variation among BCR definition. BCR defined as PSA 0.2ng/mL presents higher rates of biochemical progression, while clinical progression, assessed by metastatic disease or cancer specific mortality, was more associated with PSA 0.4ng/mL . Regardless the BCR definition, it shoud not be used as a landmark to start treatments. Although better oncologic outcomes were observed when salvage treatment was administrated at lower PSA levels, the correct timing of its administration depends on pathologic features, functional status, quality of life effects and patients preferences .
Han and colleagues evaluated 2.091 men submited to RP without adjuvant radiotherapy for a median follow-up of 5.9 years. Recurrence was noted in 17% of patients. Overall actuarial 5, 10 and 15 year BCR rates were 16%, 28% and 39%, respectively. Same years rates for metastatic disease were 4%, 11% and 19% and for PCa specific mortality 1%, 4% and 11%, respectively .
When To Get Tested
You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.
Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.
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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.
Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
How Is Psa Testing Used For Pretreatment Staging Of Prostate Cancer
Once prostate cancer is diagnosed by the presence of cancer cells on prostate biopsy and assigned a cancer grade , PSA is used in combination with the grade of the prostate cancer to determine further medical studies needed for cancer staging. Staging determines if the cancer is localized or metastatic . Staging therefore drives the best management and appropriate treatment for the cancer. As mentioned earlier, serum PSA levels correlate with the risk of prostate cancer extension outside of the prostate including seminal vesicle invasion as well as metastasis to the pelvic lymph nodes.
During Treatment For Advanced Prostate Cancer
When treatments such as hormone therapy, chemotherapy, or immunotherapy are used for more advanced prostate cancer, the PSA level can help show how well the treatment is working or when it might be time to try a different treatment.
Treatments should lower the PSA level , although in some cases they may just help keep it from rising further, or even just slow the rise. Of course, other factors, such as whether youre having symptoms from your cancer and whether imaging tests show it is growing, are also important when deciding if it might be time to change treatments.
If the cancer has spread outside the prostate, the actual PSA level is often not as important as whether it changes, and how quickly it changes. The PSA level itself does not predict whether or not a man will have symptoms or how long he will live. Many men have very high PSA levels and feel just fine. Other men with low PSA levels can have symptoms.
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What Is A Normal Psa Reading Post Prostatectomy
A few months after a prostatectomy, the PSA level should be undetectable or very low, explains the American Cancer Society. The first PSA test should be taken no earlier than six to eight weeks after surgery because the protein takes time to clear out of the blood.
The presence of any PSA after surgery is often a cause of concern for patients because rising PSA levels can mean prostate cancer recurrence, according to the American Cancer Society. Cancer is not always the cause, however, and PSA levels that are very low, steady and not rising can be produced by normal, leftover prostate tissue, says the Prostate Cancer Foundation.
When the protein is detectable after surgery, doctors frequently measure PSA levels a few times to determine if they are increasing, according to the Prostate Cancer Foundation. Cancer recurrence is considered to be indicated by a PSA level that is greater than 0.2 nanogram per milliliter that has risen at least twice in an interval of two or more weeks. When this occurs, doctors often proceed to salvage radiation therapy. This procedure is frequently performed with external beam radiation and aims to destroy the remaining prostate cancer cells.
Treatment Of Rising Psa
If PSA levels are rising slowly or by a small amount, a person may not need treatment. A doctor usually considers an individuals overall health, medical history, and age when giving advice on treatment.
Doctors often use active surveillance if PSA levels are rising. Active surveillance is a series of regular tests and health checks, with treatment only if necessary. Prostate cancer often progresses very slowly, so it may be many years before a person needs treatment.
If a person has had a prostatectomy, a doctor may also recommend radiation therapy, which kills cancer cells using high-energy particles.
Radiation therapy is not suitable for everyone who has had a prostatectomy. If a person had radiation therapy before surgery, they cannot usually have this treatment again. Having radiation therapy a second time can cause side effects.
Doctors may also use hormone therapy to shrink a persons tumors. This can make other treatments such as radiation therapy more effective.
It is not always possible to prevent PSA levels from rising. The best way to safeguard health after having a prostatectomy is by undergoing regular medical checks.
- stopping smoking or using tobacco products
- exercising regularly
- eating a healthful diet, with plenty of fruits and vegetables
- limiting alcohol intake to a moderate amount
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What Is This Post All About
This is a hard decisionsurgery or radiation?
Now remember, what I am going to talk about here is for prostate cancer that hasnt spreadLOCALIZED prostate cancer.
;From a 30,000-foot view,;surgery and radiation or both EXCELLENT treatment choices for prostate cancer.; In general, you can pick and choose certain studies to support one treatment over the other but by and large they are both EQUAL in terms of cancer control.;
Now remember,;I am a urologist. I try my hardest to provide as unbiased as an opinion as I can but its impossible to remove the fact that I am urologist when providing this information. This is why;I will always have my patients meet with a Radiation Oncologist;as well as me;to hear from them about what radiation is all about as I talk to them about what surgery is all about.;;
Psa Levels After Treatment
A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.
The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.
Your PSA level should drop so low that its not possible to detect it at six to eight weeks after;surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.
After;radiotherapy;or;brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.
Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.
If your PSA level rises by 2 ng/ml or more above its lowest level, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.
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What Happens If My Psa Level Is Elevated
If you have a high PSA level, you will need ongoing PSA tests and DREs so your provider can look for any changes. If the PSA level continues to increase or if your healthcare provider finds a lump during a DRE, you may need other tests, including:
- Transrectal ultrasound and prostate biopsies.
- Prostate MRI.
- Iso PSA or 4Kscore® .
A biopsy can tell you definitively if you have prostate cancer. The biopsy results also affect your treatment. For example, if the biopsy shows a lot of cancer cells, you might need more aggressive treatment.
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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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.
Follow Up After Radical Prostatectomy
The prostate gland, seminal vesicles and any lymph nodes removed will be sent to a pathologist to be looked at under a microscope. The results can give a clearer idea of how aggressive the prostate cancer might be, the grade, and whether it has spread beyond the confines of the prostate, the stage.A ”positive surgical margin” means there are cancer cells on the edge of the tissue removed. It leaves the possibility that some cancer cells may have been left behind, requiring further treatment in the future.
A ”negative or clear surgical margin” means that the tumour removed was surrounded by a layer of healthy tissue, suggesting that all the tumour has been removed.;
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Psa Monitoring After Radical Prostatectomy
PSA monitoring after radical prostatectomy is an essential way of understanding whether or not all the cancer cells have been removed. The PSA is usually checked every three months for the first one to three years and then 6 to 12 monthly thereafter. Following a radical prostatectomy, the most widely accepted definition of a recurrence is a confirmed PSA level 0.2 ng/mL.;
If the PSA does rise above this level, the urologist may try to determine where the recurrent cancer cells are located. This may involve arranging scans such as an MRI, bone scan or CT. In cases where the PSA is very low, the clusters of prostate cancer cells might be too small to detect on any imaging tests. So sometimes pelvic radiotherapy is offered based on the probability of cancer cells being present rather than actually seeing tumour recurrence on scans. Newer molecular imaging scans, including C11-choline, F18-fluciclovine, and PSMA PET scans, can be done at select centres. These scans can more precisely identify prostate cancer metastases in the body and are significantly more sensitive than traditional bone and CT scans. All scans can, however, have difficulty in finding tumours when the PSA level is very low.;
Questions To Think About Before Having A Psa Test
To help you make your decision, you could think about the following questions:
- What would you do if your PSA level is high?
- What would you do if further tests find that you have an early prostate cancer?
- What difference will it make for you to know about an early prostate cancer?
Before you decide whether to have the PSA test, you may want to talk to your GP about it. You can also call our cancer support specialists on 0808 808 00 00. They can discuss the options with you and send you more information.
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Treatment Options After Recurrence
After surgery to remove your prostate
PSA levels are usually extremely low about a month after surgery. You may hear your doctor saying that your PSA level is undetectable . If your PSA level starts to rise,;this might mean the cancer has come back.
Your doctor might recommend:
- hormone treatment
After external beam radiotherapy
PSA levels usually get lower slowly over months or years. Defining the limit for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence, or;3 increases in a row .
Your treatment options may be:
- surgery to remove your prostate
- hormone treatment
- high;frequency ultrasound
After internal beam radiotherapy
PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence.
After hormone treatment
If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static.;If it rises this may suggest the cancer is becoming resistant to the hormone treatment.
If hormone treatment is no longer controlling your cancer, your doctor may suggest:
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What Is The Prostate Gland
The prostate gland is about the size of a walnut and surrounds the neck ofa man’s bladder and urethrathe tube that carries urine from the bladder.It’s partly muscular and partly glandular, with ducts opening into theprostatic portion of the urethra. It’s made up of three lobes, a centerlobe with one lobe on each side.
As part of the male reproductive system, the prostate gland’s primaryfunction is to secrete a slightly alkaline fluid that forms part of theseminal fluid , a fluid that carries sperm. During male climax, the muscular glands of the prostate help to propel the prostatefluid, in addition to sperm that was produced in the testicles, into theurethra. The semen then travels through the tip of the penis duringejaculation.
Researchers don’t know all the functions of the prostate gland. However,the prostate gland plays an important role in both sexual and urinaryfunction. It’s common for the prostate gland to become enlarged as a manages, and it’s also likely for a man to encounter some type of prostateproblem in his lifetime.
Many common problems that don’t require a radical prostatectomy areassociated with the prostate gland. These problems may occur in men of allages and include:
Cancer of the prostate is a common and serious health concern. According tothe American Cancer Society, prostate cancer is the most common form ofcancer in men older than age 50, and the third leading cause of death fromcancer.
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