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Prostate Cancer

Post Radical Prostatectomy Elevated PSA

06/23/2009

Question:

I had a robotic radical prostatectomy about 3 years ago. The pathology report indcated that the margins were clear. Post surgery, my PSA was .02. Since that time, my PSA has risen to .07. I have had opinions from do nothing and just watch the numbers to you must have radiation immediately. I have also been told that the numbers may indicate a problem in other areas. My history includes non-hodgkins lympoma, hodgkins disease, melanoma and prostate surgery. It has been 12 years since my original diagnosis. I have been treated with chemotherapy, radiation, and surgery. I am not thrilled about another procedure. What advise, at this point, would you have? My experience has been that whatever the medical specialists training is, is what he/she reocmmends. I am at a loss and do not know what to do. HELP!

Answer:

I understand your frustration in this. Unfortunately, there are often debate among these issues. After surgery if your PSA begins to rise there is definitely a concern regarding a recurrence and radiation therapy would be appropriate to consider. I do not believe this is related to your history of non-hodgkins lymphoma or melanoma.

I would recommend a consultation with a radiation oncologist. There is evidence in the medical literature that supports salvage radiation therapy to the pelvis for rising psa after radical prostatectomy. Our multidisciplinary team would recommend being treated with radiation before your PSA reaches 1.0. We would certainly order a bone scan and CT scan of the pelvis too.

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Response by:

Lee E Ponsky, MD Lee E Ponsky, MD
Associate Professor of Urology
School of Medicine
Case Western Reserve University