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Prostate Cancer

PSA After Surgery

07/22/2009

Question:

I had a radical prostatectomy and my PSA after three months was 0.5 My doctor suggests I wait for three more months to get it tested again. Is my PSA too high already? Should I also get radiation or other treatment? Isn`t it supposed to be undetectable.

Answer:

PSA after radical prostatectomy is the most sensitive measure of residual prostate tissue. The significance of a measurable PSA should be correlated with the pathology report that provides information regarding the presence of prostate tissue at the resection margin and whether that tissue is benign or cancer. In addition, the pathology report provides information regarding the histology of the cancer which is an indication of the aggressiveness of the tumor (Gleason grade and Gleason score).

The best result of a post radical prostatectomy PSA is undetectable, but different centers use different values as benchmarks. Some labs do not report PSA values below 0.1 ng/ml while others run more expensive assays that are capable of detecting PSA's as low as 0.05 ng/ml. Typically, after prostate removal, PSA is checked at 6 weeks, 3 months, and every 3 months for one year. More frequent testing may not provide benefit since there is some variation due to the very small amount of PSA that is being meaured.

In general, PSA doubling time less than 3 months is of concern and will lead to more aggressive treatment. If PSA is gradually rising, then supplemental radiation therapy can be delayed while the patient works to regain continence. If radiation therapy is indicated, best results are in patients whose PSA is less than 1.0 ng/ml. I think your physician is correct to time the next PSA at 3 months from the first one that you reported in your note.

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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