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Prostate Cancer

Post Prostate Surgery PSA

02/20/2009

Question:

I had prostate surgery 4 months ago. Prior to surgery my PSA was 7.5 with a Gleason score of 3+3. General consensus (CT scan, bone scan) was that the cancer was confined to the prostate. Lab results after the suregery indicated the cancer was confined to 5% of the prostate with no indications that it escaped. BUT, my PSA after 3 months was 3.6 and after 4 months 2.1. Are you aware of any situations like this where the PSA has a chance to go to zero, like it was suppossed to?

Answer:

Typically, PSA reaches nadir (essentially undetectable) six weeks following surgery to remove the prostate. Possible explanations of a persistent PSA after radical prostatectomy might include remnant prostate tissue which could be either cancer or benign tissue. Based upon the progressive decrease in PSA, I would suggest continued PSA surveillance during the first year at 3 month intervals. If PSA begins to increase, then ProstaScint scan might be useful to identify location of residual prostate tissue. If localized in the pelvis, radiation therapy can be used as an adjuvant mode of therapy. You should discuss strategy with your urologist.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati