Question: I had a radical prostatectomy in December 2000 followed by eight weeks of radiation treatment. After that, there was no detectable Prostate Specific Antigen (PSA) reading in my blood tests until yesterday when a reading of 0.1 was recorded. The urologist said not to panic and he would see me again in three months. He said the test was very sensitive and there may be no detectable PSA on the next blood test. What I can expect? Should I begin to prepare for the worst?
Dr. Hibberd's Answer:
Relax, your urologist is correct. The mere presence of PSA at such a low level eight years after surgery has no diagnostic or treatment significance unless a clinical exam finds suspicious tissue, or the PSA reading increases in three months.
Prostate Specific Antigen (PSA) levels detected by a simple blood test have revolutionized the care of prostate issues. Before, there was no reliable test to gauge prostate inflammation in men who had either prostate cancer or benign prostate problems. Even if a man’s PSA is within the normal range (usually four to ten), any trending elevation is to be closely watched. A biopsy should be considered when the PSA level doubles, when there is a continuous persistent trend in elevation, or when elevations exceed 2.0 points above the man’s usual baseline.
Interpretation is entirely different for post-operative surveillance. These normal levels do not apply when you have received a prostatectomy with radiation when your PSA is ideally expected to be undetectable. Within six to 12 months of surgery, your PSA is expected to remain under 0.5. While it’s difficult to determine thresholds for intervention, a return of PSA after surgery must be regarded with suspicion. Patients are generally monitored every three months initially then every six months for several years. Guidelines for intervention are patient specific and caution is advised when basing treatment choices on PSA levels alone. While not all prostate cancers cause elevated PSA levels, when they are elevated in the presence of confirmed prostate cancer, the PSA is a very useful marker for measuring the disease’s response to treatment and for the early detection of a recurrence.
A PSA elevation alone does not necessarily indicate cancer. It will occur with a number of prostatic disorders that include cancer and any inflammation of prostate tissue often caused by infection or prostatic calculi (small stones within the prostate). Having had a prostatectomy and radiation with confirmed absence of PSA is definitely a desired goal, but the mere presence of a minimal PSA does not confirm recurrence of malignancy. It may simply be a change in test methodology or it could reflect the presence of prostate tissue that is producing PSA.
Follow your doctor's advice and remember that this PSA test is non-specific. Trending is now regarded as one of the test’s best uses. Treatment of recurrence of malignancy after surgery requires evaluation for both local and distant recurrence of disease, and is often initially treated by hormone (anti-testosterone and estrogenic) manipulations.
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