Is PSA zero after prostatectomy?

The PSA level after prostatectomy is expected to be zero or at undetectable levels unless the prostate cancer cells had already spread to other parts of the body. It is important to note that a 0.2 ng/ml level of PSA is not alarming when first diagnosed with prostate cancer.

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PSA (prostate-specific antigen) blood tests are a familiar routine for men over the age of 40. This test is typically used as a screening tool for prostate cancer and has helped countless men detect and treat their prostate cancer early. When treated early, the cure rate for prostate cancer is upwards of 95%. The purpose of this article, however, is not to discuss Elevated PSA after prostatectomy can be a real concern for some patients. PSA (prostate-specific antigen) blood tests are a familiar routine for men over the age of 40. This test is typically used as a screening tool for prostate cancer and has helped countless men detect and treat their prostate cancer early. When treated early, the cure rate for prostate cancer is upwards of 95%. The purpose of this article, however, is not to discuss routine PSA screenings and early treatment. We are here to see what happens after preliminary treatment like robotic surgery and the removal of the prostate.

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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 (removal of the prostate) is an undetectable PSA or 0 PSA level. The surgery itself is a cornerstone of a man’s 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?

What is considered rising PSA after prostatectomy?

After radical prostatectomy, it takes the PSA quantities in patients’ blood to drop to undetectable levels in four to eight weeks. Within this timeframe, the doctors will perform the first PSA test after prostatectomy in order to determine whether there are any signs left of prostate cancer. So, the question is: “Can you have a PSA reading after the surgical removal of the prostate gland?” Since PSA is a type of protein produced only by prostate cells and prostate cancer cells, when you eliminate one of the two sources of PSA, any trace of PSA presence can indicate the only source left: a prostate tumor. This usually happens when the tumor is advanced at the time of surgery and could have already spread its cancer cells to other parts of the body. It is considered elevated PSA after prostatectomy a PSA greater than 0.2 ng/ml. If the prostate cells are grown enough to generate detectable levels of PSA, this could be an alarming point both for the patient and the doctor. It is important to note that a 0.2 ng/ml level of PSA is not alarming when first diagnosed with prostate cancer. That’s because the prostate gland generates a certain level of PSA by itself, even in healthy men. However, the same reading becomes a reason for concern after a radical removal of the prostate gland. The PSA level after prostatectomy is expected to be zero or at undetectable levels unless the prostate cancer cells had already spread to other parts of the body. It is important to note that a 0.2 ng/ml level of PSA is not alarming when first diagnosed with prostate cancer. That’s because the prostate gland generates a certain level of PSA by itself, even in healthy men. However, the same reading becomes a reason for concern after a radical removal of the prostate gland. The PSA level after prostatectomy is expected to be zero or at undetectable levels unless the prostate cancer cells had already spread to other parts of the body.

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Recurrent prostate cancer – When is it happening?

According to the Prostate Cancer Foundation, there are 20-30% chances of prostate cancer recurrence after prostatectomy after five years of initial prostate cancer treatment. This includes both surgical intervention and radiation treatment. As a patient, the prospect of PSA recurrence can be very worrisome. What many patients do not know is that not all modified levels of PSA after prostate cancer treatment indicate recurrent prostate cancer. Some types of levels are much more troublesome than others and treatment approaches can vary tremendously case by case. When PSA results are equal or greater than 0.2 ng/mL according to an initial test, then the second test was taken two weeks after returns with even a slight increase in PSA levels, then the case turns into a biochemical recurrence. This evolution of the disease can happen within 7 to 28 months after surgery or from 24 to 46 months. Life expectancy after biochemical recurrence of prostate cancer is 94% of 5.6 years after the diagnosis. Not all changes in the PSA levels mean recurrent prostate cancer after robotic surgery or other forms of treatment. Elevated PSA after prostatectomy may also indicate other conditions, that is why the PSA check is essential after surgery.

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 (ng/mL). 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.

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.

Elevated PSA after prostate removal – What influences the predictions?

As previously noted, elevated PSA after prostate removal can mean many different things in terms of the status of prostate cancer. These different prognoses are based on several different factors, outlined below:

Gleason Score of Prostate Cancer: The Gleason score is a measure of how aggressive the cells of prostate cancer are. The higher the score, the more aggressive the cancer is. Men with higher Gleason scores who experience PSA recurrence are at greater risk for metastasis of prostate cancer than those men with lower Gleason scores. Is the Gleason Score 7 or less or is it 8 or higher?

Time from Surgery: How soon after surgery the PSA reappears is one indicator specialists use to determine the aggressiveness of cancer. Generally, the longer the time between surgery and PSA recurrence, the less likely cancer is aggressive and going to spread. In turn, the better rate of survival will be. Is the time greater or less than 2 years?

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PSA Doubling Time: The term refers to the time it takes for the PSA to double in value. The value measures the rate at which the PSA rises, and can be a very significant indicator of the aggressiveness of cancer. Men with a shorter PSA doubling time postoperatively are more likely to have more aggressive disease. In these cases, a more aggressive secondary treatment plan may be advised. Is the PSA doubling in less or greater than 10 months?

Interpreting the data on prostate cancer recurrence

“Depending on these factors, secondary treatment (if needed) can be individualized to best manage the case at hand. Using the PSA in this way can be crucial in mapping out a predicted course of the disease and helping patients manage their disease as best as possible. Some factor combinations could predict a localized, slow-moving cancer – best treated and cured with radiation therapy by targeting the remaining prostate cells. For example, if the Gleason score is less than 7, the PSA level started to rise more than 2 years after surgery and the PSA Doubling Time is almost a year, the chances to be cancer-free for a longer period of time are higher. (82% of patients are cancer-free after 7 years in these conditions, according to Hopkins Medicine). Other factor combinations could predict aggressive, metastatic disease, in which case hormonal treatment may be the best treatment. For example, if the Gleason Score is greater than 8, the PSA level started to rise less than 2 years after surgery and the PSA Doubling Time is less than 10 months, there are greater chances to develop metastatic cancer. (Only 15% of patients will be cancer-free after 7 years, according to Hopkins Medicine). Still in other cases, when evaluating all the aspects of the PSA and the patient, no treatment may be the best treatment”, says Dr. Samadi, Director of Men’s Health at St.Francis Hospital.

Not all PSA recurrences can mean recurrent prostate cancer

And although experiencing rising PSA after prostatectomy can be frightening, all hope is not lost. Many reoccurrences are still manageable and a cure is possible with the right treatment plan. An important point to remember is that while radiation is possible secondary treatment after surgery, the opposite is not true. Surgery is rarely possible after radiation as primary treatment. For this reason, choosing the right initial treatment for prostate cancer is crucial in your long-term care. Speak to your urologist about your specific risk factors if you have a PSA recurrence after prostatectomy and map out the right course of treatment for you.

roboticoncology.com - PSA after Prostatectomy - What could it mean? RoboticOncology.com

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