What Symptoms Should I Look Out For
If your cancer does come back, the first sign is likely to be a rise in your PSA level, rather than any symptoms. And problems will often be side effects of treatment rather than a sign that your cancer has come back.
However, its important to let your doctor or nurse know if you do get any new symptoms or side effects, or are worried that your cancer might have come back. If your cancer has come back and has spread from the prostate to other parts of the body, it can cause symptoms, such as extreme tiredness ” rel=”nofollow”> fatigue), bone pain and problems urinating.
Your doctor or nurse can help find out what might be causing your symptoms and help you manage any side effects. They can also look at your PSA level and do other tests to see whether or not your cancer might have come back.
What other tests might I have?
If your doctor or nurse is concerned about your PSA level or if you have new symptoms that suggest your cancer might have come back, they may recommend that you have some other tests, such as a prostate biopsy, MRI scan, CT scan, bone scan or PET scan.
Your doctor or nurse will explain these tests to you if you need them, or you can get in touch with our Specialist Nurses for more information.
Psa Monitoring After Radical Prostatectomy
PSA monitoring after radical prostatectomy is an essential way of understanding whether or not all the cancer cells have been removed. The PSA is usually checked every three months for the first one to three years and then 6 to 12 monthly thereafter. Following a radical prostatectomy, the most widely accepted definition of a recurrence is a confirmed PSA level 0.2 ng/mL.
If the PSA does rise above this level, the urologist may try to determine where the recurrent cancer cells are located. This may involve arranging scans such as an MRI, bone scan or CT. In cases where the PSA is very low, the clusters of prostate cancer cells might be too small to detect on any imaging tests. So sometimes pelvic radiotherapy is offered based on the probability of cancer cells being present rather than actually seeing tumour recurrence on scans. Newer molecular imaging scans, including C11-choline, F18-fluciclovine, and PSMA PET scans, can be done at select centres. These scans can more precisely identify prostate cancer metastases in the body and are significantly more sensitive than traditional bone and CT scans. All scans can, however, have difficulty in finding tumours when the PSA level is very low.
Tips To Get The Most From Your Follow
Write down any questions or concerns beforehand
It’s easy to forget what you want to say once youre at your appointment.
Bring someone with you
It can be hard to take everything in at your appointments. Some people find it helpful to take someone with them, to listen and discuss things with later. If your appointment is on the phone, you could ask a friend or family member to listen with you.
It can help to write things down during or after your appointment. Theres space for this in the appointment diary in our booklet, Follow-up after prostate cancer treatment: What happens next?
Ask to record your appointment
You could do this using your phone or another recording device. You have the right to record your appointment if you want to because its your personal data. But let your doctor or nurse know if you are recording them.
Ask for help
If there is anything bothering you, let your doctor or nurse know.
Ask for copies of any letters
If your appointment is at the hospital, ask for a copy of the letter that is sent to your GP. This will happen automatically at some hospitals. It will help to remind you of what was said at your appointment. If you don’t understand the letter, call your main contact at the hospital or contact our Specialist Nurses.
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S Used In Best Practice Statement Development
The AUA convened a multidisciplinary panel for the purpose of developing a resource about PSA testing for urologists and primary care physicians. Panel membership included six urologists, one radiation oncologist, two medical oncologists, one internist and one epidemiologist. Funding in support of panel activities was provided by the AUA. Panel members received no remuneration for their efforts, and each member provided conflict of interest disclosure.
The Panel formulated its policy statements and recommendations by consensus, based on a review of the literature and the Panel members’ own expert opinions. The current policy was based on a reassessment of the previous policy published in 2000. After Panel members agreed on the general areas to be covered, each member took on the task of conceptualizing and writing and/or revising a section of the document in an area where he/she had specific expertise. Every part of the document was thoroughly critiqued by Panel members, both in written comments and in verbal discussions in a series of conference calls. Over the course of successive manuscript revisions, the Panel scrutinized and modified the conceptual framework, reworked the wording of key statements, and reexamined supporting evidence reported in the literature until Panel members reached consensus.
Follow Up After Radical Prostatectomy
The prostate gland, seminal vesicles and any lymph nodes removed will be sent to a pathologist to be looked at under a microscope. The results can give a clearer idea of how aggressive the prostate cancer might be, the grade, and whether it has spread beyond the confines of the prostate, the stage.A positive surgical margin means there are cancer cells on the edge of the tissue removed. It leaves the possibility that some cancer cells may have been left behind, requiring further treatment in the future.
A negative or clear surgical margin means that the tumour removed was surrounded by a layer of healthy tissue, suggesting that all the tumour has been removed.
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
The Risk Of Your Cancer Coming Back
For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.
One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.
Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.
When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.
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Following Psa Levels During And After Prostate Cancer Treatment
A mans prostate-specific antigen blood level is often a good indicator of how effective treatment is or has been. Generally speaking, your PSA level should get very low after treatment. But PSA results arent always reliable, and sometimes doctors arent sure what they mean.
Before starting treatment, you might want to ask your doctor what your PSA level is expected to be during and after treatment, and what levels might cause concern. Its important to know that the PSA level is only one part of the overall picture. Other factors can also play a role in determining if cancer is still there, if it is growing, or if it has come back.
Its also important to know that PSA levels can sometimes fluctuate a bit on their own, even during or after treatment, so they may not always be a sign of what is actually happening with your cancer. Understandably, many men being treated for prostate cancer are very concerned about even very small changes in their PSA levels. The PSA level is an important tool to monitor the cancer, but not every rise in PSA means that the cancer is growing and requires treatment right away. To help limit unnecessary anxiety, be sure you understand what change in your PSA level might concern your doctor.
During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
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Psa Increases After Surgery
If your PSA is elevated after prostate cancer surgery, it can be a false positive result. It may take some time for your blood to show the results of the surgery. During your recovery, your physician will monitor the level closely. Since results immediately after surgery can be skewed, any test results should be repeated after you have fully healed and recovered. Since each patient is different, this recovery time may take a few weeks or even up to a few months. During that time, your physician will let you know how often to test your PSA. Once you fully recover, your physician may ask for further tests to determine the cause of the elevated PSA and formulate a plan for any additional treatment.
Additional Therapies After Rp
Of 634 men with complete data regarding additional therapies, 310 patients received neoadjuvant, adjuvant or salvage therapy. Thirty-three received neoadjuvant hormones. Eleven received adjuvant therapy, defined as treatment within the first year of RP without a biochemical recurrence 6, 6 and 3 received hormones, radiation and chemotherapy respectively. In total, 266 , 111 and 73 received salvage hormone, radiation and chemotherapy . One hundred twenty men received early hormones before the presence of metastatic disease 122 received delayed hormones after metastatic recurrence.
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What Your Psa Numbers Mean
The PSA test measures the level of prostate-specific antigen in your blood. The lab will report your results in nanograms of PSA per milliliter of blood.
Only the prostate gland releases PSA, so your numbers should drop to almost zero within 4 weeks after your surgery. A test result above 0.2 ng/mL a few months after your procedure could be a sign that your prostate cancer has come back. This is called a biochemical recurrence.
If your number is higher than it should be, it doesn’t mean you definitely have cancer. Results can vary from person to person and from lab to lab. A more accurate way to find out if you have cancer is to test how quickly your PSA levels rise.
A PSA velocity test measures the change in your PSA levels over time. PSA doubling time tests calculate how long it takes for your PSA levels to double. If they rise quickly, it could be a sign of cancer. Knowing how fast yours is rising can help your doctor predict whether your cancer will spread, and if — or when — you’ll need treatment.
Explanation Of Revised Document
This revised document contains the content of the “Prostate-Specific Antigen Best Practice Statement: 2009 Update” deleting that which pertains to the detection of prostate cancer. An updated guideline, available on the auanet.org website, is the 2013 AUA document “Early Detection of Prostate Cancer: AUA Guideline.” Statements related to the detection of prostate cancer have been deleted, such that this revised document addresses only the use of PSA testing for the pretreatment staging and posttreatment management of prostate cancer. No other major changes have been made.
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What Is A Normal Psa Reading Post Prostatectomy
A few months after a prostatectomy, the PSA level should be undetectable or very low, explains the American Cancer Society. The first PSA test should be taken no earlier than six to eight weeks after surgery because the protein takes time to clear out of the blood.
The presence of any PSA after surgery is often a cause of concern for patients because rising PSA levels can mean prostate cancer recurrence, according to the American Cancer Society. Cancer is not always the cause, however, and PSA levels that are very low, steady and not rising can be produced by normal, leftover prostate tissue, says the Prostate Cancer Foundation.
When the protein is detectable after surgery, doctors frequently measure PSA levels a few times to determine if they are increasing, according to the Prostate Cancer Foundation. Cancer recurrence is considered to be indicated by a PSA level that is greater than 0.2 nanogram per milliliter that has risen at least twice in an interval of two or more weeks. When this occurs, doctors often proceed to salvage radiation therapy. This procedure is frequently performed with external beam radiation and aims to destroy the remaining prostate cancer cells.
Prostate Cancer Recurrence After Prostatectomy: Why Does It Happen And How Do We Treat It
Filed in Life After Treatment
The concept of prostate cancer recurrence after prostatectomy puzzles many patients. A frequently asked question is how can the cancer come back if the prostate has been removed? The explanation is that, as with any cancer, if cancerous cells migrate out of the organ in which they arose before the organ is removed , they can settle and grow elsewhere. These migrating cells are called metastases, secondary deposits or secondaries.
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During Treatment For Advanced Prostate Cancer
When treatments such as hormone therapy, chemotherapy, or immunotherapy are used for more advanced prostate cancer, the PSA level can help show how well the treatment is working or when it might be time to try a different treatment.
Treatments should lower the PSA level , although in some cases they may just help keep it from rising further, or even just slow the rise. Of course, other factors, such as whether youre having symptoms from your cancer and whether imaging tests show it is growing, are also important when deciding if it might be time to change treatments.
If the cancer has spread outside the prostate, the actual PSA level is often not as important as whether it changes, and how quickly it changes. The PSA level itself does not predict whether or not a man will have symptoms or how long he will live. Many men have very high PSA levels and feel just fine. Other men with low PSA levels can have symptoms.
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 is an undetectable PSA or level of 0. The surgery itself is a cornerstone of a mans 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 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?
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
The Purpose Of Prostate Surgery
Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.
It has been performed for many years and was regarded as the gold standard of prostate cancer treatment. However, few studies compare its efficacy to other techniques.
Most men diagnosed with prostate cancer today are typically diagnosed with Gleason 6 cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:
Misuse of the term cancer has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.
The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they dont really have.
Aggressive treatment, usually a complete surgical removal of the prostate , is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.
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