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Psa Going Up After Prostate Removal

Treatment Of Rising Psa

PSA Recurrence: When Should You Treat? | Ask a Prostate Expert, Mark Scholz, MD

If PSA levels are rising slowly or by a small amount, a person may not need treatment. A doctor usually considers an individuals overall health, medical history, and age when giving advice on treatment.

Doctors often use active surveillance if PSA levels are rising. Active surveillance is a series of regular tests and health checks, with treatment only if necessary. Prostate cancer often progresses very slowly, so it may be many years before a person needs treatment.

If a person has had a prostatectomy, a doctor may also recommend radiation therapy, which kills cancer cells using high-energy particles.

Radiation therapy is not suitable for everyone who has had a prostatectomy. If a person had radiation therapy before surgery, they cannot usually have this treatment again. Having radiation therapy a second time can cause side effects.

Doctors may also use hormone therapy to shrink a persons tumors. This can make other treatments such as radiation therapy more effective.

It is not always possible to prevent PSA levels from rising. The best way to safeguard health after having a prostatectomy is by undergoing regular medical checks.

  • stopping smoking or using tobacco products
  • exercising regularly
  • eating a healthful diet, with plenty of fruits and vegetables
  • limiting alcohol intake to a moderate amount

Avoid Having Sex Before A Psa Test To Avoid False Results

Dr. David Samadi

Youâve made youâre appointment with the urologist for your annual PSA test. Whether a man looks forward to this doctorâs visit or not, it is a necessary part of screening for any issues that may be affecting the prostate gland.

Thereâs just one thing to remember no sex for 48 hours before the test.

A PSA, or prostate specific antigen test, is a simple blood test that measures the amount of prostate specific antigen present in the blood.

PSA is a protein that men have in their blood which is released by the prostate gland. In healthy males, the amount of PSA men have in their blood is low generally less than 4.0 ng/mL.

However, when men age, their prostate can experience physiological or pathological changes which cause the PSA to rise.

However, the PSA test is far from foolproof. Values of the PSA test can vary depending on when the test is administered. A man can help get the most accurate score by following certain suggestions before he has the PSA test done.

Low Detectable Psa After Prostatectomy Watch Or Treat

In a previous article, we looked at evidence that a low detectable level of PSA predicts eventual biochemical recurrence when there is aggressive pathology. But what is one to do when the pathology report is not necessarily poor , yet the PSA is detectable and possibly rising?

Because several randomized clinical trials have demonstrated an advantage to earlier treatment over waiting, the National Cancer Center Network , which comprises many to the top US cancer centers, uses a lower threshold for defining biochemical recurrence:

  • PSA detectable after prostatectomy, or
  • PSA undetectable after prostatectomy that is subsequently detectable on at least two PSA tests

The NCCN definition may lead to over-treatment of patients in whom the small amounts of PSA may be attributable to benign tissue left behind, extraprostatic sources, or indolent cancer that may never progress in the patients lifetime. On the other hand, waiting for the American Urological Association definition of a confirmed PSA greater than 0.2 ng/ml may allow the cancer time to progress beyond the local area.

  • Undetectable PSA
  • PSA greater than 0.03 and less than 0.2 ng/ml
  • No two subsequent increases in PSA, and/or
  • PSA velocity less than 0.05 ng/ml/yr
  • Low detectable, unstable PSA
  • PSA greater than 0.03 and less than 0.2 ng/ml
  • Two subsequent increases in PSA, and/or
  • PSA velocity of 0.05 ng/ml/yr or greater
  • The 7-year recurrence-free survival rates for the three groups were found to be:

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    Can I Have Radiation Therapy First And Then Surgery

    With modern radiation therapy techniques, local tissue damage is often kept at a minimum, and surgeons at some of the larger cancer centers have been seeing improved results with salvage prostatectomy performed after radiation. But even under the best of circumstances, post-radiation surgery is a very difficult operation to perform, and few surgeons across the country perform it regularly.

    When Should I Get A Psa Test

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    The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.

    • If you are between ages 45 and 75:
    • Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
    • If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
    • If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
    • If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
  • If you are over 75:
  • If you continue testing and your PSA is less than 3 ng/mL and your DRE is normal, repeat testing every 1-4 years
  • If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
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    What Other Tests Do I Need

    After prostatectomy, youll probably have a PSA test in about six weeks or so. Your doctor will recommend a follow-up schedule, usually every three months for two years. Depending on the results, you may need to test once or twice a year thereafter. Testing may be more frequent if it appears to be rising.

    If your PSA levels are high and you have symptoms such as bone pain, imaging tests can be used to determine if cancer has spread. These may include bone scans and CT scans. If a mass is found, a biopsy can determine if its cancerous.

    You might not need treatment right away. If youve had multiple PSA tests and it appears that your PSA level is rising, a number of other factors determine the next steps. These factors include:

    • age and life expectancy
    • if cancer has spread and where
    • previous treatments

    Radiation therapy after prostatectomy, also known as salvage radiotherapy, can be quite effective after a prostatectomy. External beam radiation can be delivered directly to the area around where the prostate was. The goal is to destroy prostate cells that may have been left behind after surgery. This lowers the risk of recurrence and metastasis, or of the cancer spreading.

    Metastatic prostate cancer may not be curable, but there are treatments to slow progression and manage symptoms. Treatments may include:

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    Pros And Cons Of The Psa Test

    Pros:

    • it may reassure you if the test result is normal
    • it can find early signs of cancer, meaning you can get treated early
    • PSA testing may reduce your risk of dying if you do have cancer

    Cons:

    • it can miss cancer and provide false reassurance
    • it may lead to unnecessary worry and medical tests when theres no cancer
    • it cannot tell the difference between slow-growing and fast-growing cancers
    • it may make you worry by finding a slow-growing cancer that may never cause any problems

    What Are Antiandrogens And Should They Be Part Of My Treatment Plan

    PSA After Radiation | Ask a Prostate Expert, Mark Scholz, MD

    Antiandrogens can be helpful in preventing the flare reaction associated with LHRH agonists resulting from an initial transient rise in testosterone. They can help block the action of testosterone in prostate cancer cells. Their use for at least the first 4 weeks of LHRH agonist therapy can relieve the symptoms often seen from the flare reaction, ranging from bone pain to urinary frequency or difficulty. You should ask your doctor whether continuing these pills for longer-term cancer control might be beneficial for you.

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    What Factors Increase The Chance Of Cancer Recurrence

    The likelihood of metastasis occurring increases with higher grade and stage of the cancer as the more aggressive and developed the cancer is, the higher the chance of it breaking out of the prostate. More specifically:

    • High Gleason grades
    • High clinical stages
    • Positive surgical margins .

    However, most prostate cancers are cured with surgery. As an example, using my results from operations performed on over 2,300 men with a variety of stages and grades, 96.3% of operations resulted in full cancer cure. Some combinations of minor prostate cancer had a 100% cancer cure rate, but the higher you go, the lower the full cancer cure rate.

    The commonest sites of recurrence of prostate cancer following surgery are:

    • the prostate bed 80% of recurrence cases
    • lymph nodes 15% of cases
    • bones 5% of cases.

    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.

    Read Also: What Happens When You Remove Your Prostate

    Why You Have The Test

    The goal of a prostatectomy is to remove all the cancer, or as much of it as possible. If your cancer hasn’t spread, it might cure you.

    But no surgery is perfect. It’s possible that some of the cancer cells spread outside your prostate before your procedure. Or the operation might have left a few cancer cells behind. Those cells could start to grow in the future.

    A regular PSA test after a prostatectomy is a way for your doctor to keep tabs on your treatment. It can help your doctor see how well your surgery worked, and if your cancer has come back.

    Redefining The Role Of Psa After Prostate Cancer Removal

    Nuclear

    One of the most well-knownand controversialmethods of cancer detection is the PSA test. PSA stands for prostate-specific antigen, the marker in blood that can indicate the presence of prostate cancer.

    The PSA test was developed at Roswell Park Comprehensive Cancer Center in the 1970s and was initially intended to check for returning prostate cancer in men who had already undergone treatment. Later, many doctors began using it in healthy men to screen for an initial diagnosis. It has helped diagnose millions of men across the world and saved countless lives.

    But in recent years, the usage of the PSA test has undergone scrutiny, with some saying it can lead to over diagnosis or unnecessary treatment. A recent study completed at Roswell Park is helping redefine how we use the PSA test by demonstrating that even when PSA is present, the levels of the marker can be a key indicator of what treatment is necessaryor unnecessary.

    After a patient is diagnosed and his prostate is removed surgically, the PSA test is used to see if any cancer remains. About 30 percent of men in this situation will have detectable PSA in their blood. The standard course of treatment has been to have men with any detectable PSA undergo radiation therapy. However, for some men, radiation may not be needed.

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    Side Effects Of Treatment

    Treatments for prostate cancer can cause side effects, which might carry on after your treatment has finished. Some side effects can even start several months or years after treatment finishes.

    Side effects will affect each man differently you may not get all the possible side effects from your treatment.

    Read more about:

    Managing side effects

    Side effects can affect your day-to-day life, but there are treatments for them, as well as things you can do to manage them yourself. Its important to speak to your doctor, nurse or GP about them.

    If youre having problems with a side effect, you might have a meeting with your doctor or nurse to work out what support you need. They may refer you to someone who can give you more advice and support.

    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.

    Make notes

    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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    What If My Psa Rises While Im On Hormone Therapy

    When the PSA is rising or cancer is spreading despite a low level of testosterone, prostate cancer is called castration-resistant, or hormone-refractory. Despite this name, some hormonal therapies may still work. But prostate cancer in this setting may progress and become more aggressive and resistant, and you should be prepared to discuss additional treatment strategies with your doctor. This is the time when a medical oncologist, if not already involved in your care, gets involved. These doctors specialize in medical, systemic treatments for prostate cancer, which is useful at this time given that your disease is typically metastatic, meaning that it is not confined to only one location. Cancer cells in this situation have typically spread through the blood stream or lymphatics to other places in the body, and localized treatments are rarely helpful except in circumstances where where you are having symptoms, such as problems with urination.

    Fortunately, more and more treatments for metastatic castration-resistant prostate cancer have become available in recent years, including certain newer androgen directed therapies, taxane chemotherapy, immunotherapy, PARP inhibitors, and, in 2022, lutetium-PSMA radionuclide therapy. Additional tests are required for some of these treatments to see if your particular type of prostate cancer is likely to respond. See Chapter 5 in PCFs Prostate Cancer Patient Guide for more details.

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    PSA Relapse after Surgery or Radiation | Prostate Cancer Staging Guide
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    Treatment Options After Recurrence

    After surgery to remove your prostate

    PSA levels are usually extremely low about a month after surgery. You may hear your doctor saying that your PSA level is undetectable . If your PSA level starts to rise, this might mean the cancer has come back.

    Your doctor might recommend:

    • radiotherapy to where the prostate was
    • hormone treatment

    After external beam radiotherapy

    PSA levels usually get lower slowly over months or years. Saying at what level your PSA should be for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence, or 3 increases in a row .

    Your treatment options may be:

    • surgery to remove your prostate
    • hormone treatment
    • high frequency ultrasound

    After brachytherapy

    PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence.

    After hormone treatment

    If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static. If it rises this may suggest the cancer is becoming resistant to the hormone treatment.

    If hormone treatment is no longer controlling your cancer, your doctor may suggest:

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