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What Does Elevated Psa Mean After Prostate Removal

Psa Levels 5 Years After Radiation Therapy Predict Survival From Prostate Cancer

Managing a Rising PSA after Radical Prostatectomy

The level of prostate-specific antigen in the blood of prostate cancer patients five years after radiation treatment can help predict their disease-free survival for the next several years, according to the October 2002 issue of the International Journal of Radiation Oncology, Biology and Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology.

Researchers have discovered that patients who maintain very low five-year PSA levels have a very low probability of relapse at 10 years and beyond.

The study identified 328 men treated with external beam radiation therapy to the prostate who were biochemically disease-free five years after treatment. The median follow-up was 7.4 years. The patients were divided into four groups according to their PSA values five years after treatment: PSA less than or equal to 0.5, 0.5 to 1.0, 1.0 to 2.0 and 2.0 to 4.0 ng/mL. PSA progression-free rates were calculated in each subgroup at 10 years after treatment.

Researchers concluded that when PSA levels remain low five years after external beam radiation therapy, the great majority of patients will be biochemically disease-free at 10 years. The hazard rates of biochemical progression in the 6 to 10 years after treatment are low and are comparable to rates seen when prostatectomy is the chosen treatment modality.

Does A High Psa Mean I Have Prostate Cancer

For many years, one of the primary screening tests for prostate cancer was a PSA test. If the number was high, further testing for prostate cancer was likely. Recently, however, doctors have found that an elevated PSA isnt a sure sign of prostate cancer. While it could be an indicator of cancer, it can also be a sign of other non-cancerous prostate conditions.

What You Need To Know About The Prostate What Does Elevated Psa Mean After Prostate Removal

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

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If Prostate Cancer Returns

Sometimes prostate cancer does come back after treatment, which is known as a recurrence. If your PSA level starts to rise and the cancer has not spread beyond the prostate, this may mean you still have cancer cells in the prostate area. If this happens, you may be monitored with regular blood tests or you may be offered further treatment, which is known as salvage treatment.

Your options will depend on the treatment you had. If you had surgery, you may be offered radiation therapy, and if you had radiation therapy, you may be offered further radiation therapy, surgery or other treatments. If the cancer has spread beyond the prostate, androgen deprivation therapy is usually recommended and sometimes radiation therapy may be recommended. Surgery may be an option in some cases. You may be offered palliative treatment to manage symptoms.

It is possible for the cancer to come back in another part of your body. In this case, you may have treatment that focuses on the area where the cancer has returned. Talk to your doctors about the options. You can also call Cancer Council 13 11 20 for more information.

Radiation Therapy: Conclusions And Recommendations

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Unfortunately, the majority of men with a rising PSA above their nadir value after radiation therapy are not candidates for a local salvage procedure. Physical examination is more difficult based upon postradiation fibrosis, and the presence of residual disease in the prostate should be evaluated with ultrasound and prostate rebiopsy in those men who are potential candidates for a salvage procedure. Cross-sectional imaging is needed to decide if residual disease is clinically confined to the prostate or whether local progression has occurred. Cystoscopy should be performed to evaluate for possible bladder neck involvement. Metastatic disease should be ruled out using chest radiographs, radionuclide bone scan, and additional pelvic or abdominal imaging as indicated.

Men without metastatic disease and extensive regional local extension may be candidates for a salvage procedure. Recurrent cancer that is confined to the prostate has the best chance of long-term cure. Overall, these procedures are marked by significant potential morbidity. They are most appropriate for younger, otherwise healthy men who are willing to accept the increased risk in the hope of eventual cure.

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Redefining The Role Of Psa After Prostate Cancer Removal

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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What Is Hormone Therapy For Prostate Cancer

Androgen deprivation therapy is a key treatment strategy for prostate cancer that has recurred following local treatment. The goal of all hormone therapies is to stop the production and/or interfere with the effects of testosterone, which fuels the growth of prostate cancer cells. However, because not all prostate cancer cells are sensitive to increases or decreases in testosterone levels, hormone therapy is a treatment for prostate cancer but does not cure the disease. The decision on starting testosterone lowering or blocking therapies is individualized, based on your PSA, the PSA doubling time, whether the cancer has spread visibly or caused symptoms, and the potential risks involved with this type of therapy.

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Research Shows A Promising New Option For Men Who Experience Rising Psa After A Radical Prostatectomy

Many men who undergo surgical treatment for prostate cancer live out their lives without a recurrence of their disease. But 20% to 40% of them will experience a rise in prostate-specific antigen levels within 10 years of the operation. PSA should be undetectable in blood if the prostate has been removed, so elevated levels signify that the cancer may have returned. Doctors call this a biochemical relapse, and ordinarily they treat it by giving radiation to the prostate bed, which is where the prostate resided before it was taken out. Referred to as pelvic bed radiation therapy, or PBRT, this sort of treatment often succeeds in bringing PSA back down to zero for years.

Now, a large study shows that PBRT is even more effective when combined with other treatments. The findings are a potential game-changer for men experiencing a biochemical relapse after radical prostatectomy.

Funded by the National Cancer Institute, the SPPORT phase 3 clinical trial was conducted at nearly 300 medical centers across the United States, Canada, and Israel. A total of 1,797 men were enrolled between 2008 and 2015, all with post-surgical PSA levels ranging between 1 and 2 nanograms per milliliter .

Caring For The Catheter

High PSA & Prostatitis | Ask a Prostate Expert, Mark Scholz, MD

You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.

To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.

We will provide most of the supplies you need to care for your catheter. They include:

  • StatLock Foley catheter securement device
  • Shaving supplies

You should empty the catheter bag when it’s half full. This helps prevent air locks from developing in the tubing.

To apply the leg bag:

  • Wash your hands with soap and water.
  • Remove the tape at the joint of the catheter tube and bag.
  • Swab all connecting areas with alcohol pads.
  • Drain, then remove the big drainage bag.
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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.

    Radical Prostatectomy Perineal Approach

  • Youâll be placed in a supine position in which the hips and knees will be fully bent with the legs spread apart and elevated with the feet resting on straps. Stirrups will be placed under your legs for support.

  • An upside-down, U-shaped incision will be made in the perineal area .

  • The doctor will try to minimize any trauma to the nerve bundles in the prostate area.

  • The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.

  • The seminal vesicles may be removed if thereâs concern about abnormal tissue in the vesicles.

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    An Increased Psa Level

    A biochemical relapse is when your PSA level rises after having treatment that aims to cure your cancer.

    You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA rises quickly or stabilises. You might have a scan if your PSA rises quickly.

    The choice about whether to have treatment and what treatment to have will depend on:

    • the treatment you have already had
    • your general health

    The Purpose Of Prostate Surgery

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    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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    What Happens If My Psa Rises After Surgery

    PSA, or prostate-specific antigen, is a protein in the blood produced by the prostate. It is used as an indicator in a mans blood to determine the health of the prostate. An elevated PSA can indicate prostate cancer, but other non-cancerous issues can cause elevated PSA as well. Two of the most common non-cancerous causes of elevated PSA levels are prostatitis and benign prostatic hyperplasia . Prostatitis is an inflammation of the prostate, and benign prostatic hyperplasia is an enlargement of the same organ. Issues that lead to an elevated PSA can cause reduced fertility or even infertility in men. Many of these issues can be successfully treated, cured, or reduced. Since the PSA test is just an indicator, it is important to run further tests to find the cause of an elevated PSA level. Read more about what happens when PSA rises after surgery.

    What Is The Psa Test

    Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter of blood.

    The blood level of PSA is often elevated in people with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the PSA test to be used in conjunction with a digital rectal exam to aid in the detection of prostate cancer in men 50 years and older. Until about 2008, many doctors and professional organizations had encouraged yearly PSA screening for prostate cancer beginning at age 50.

    PSA testing is also often used by health care providers for individuals who report prostate symptoms to help determine the nature of the problem.

    In addition to prostate cancer, several benign conditions can cause a persons PSA level to rise, particularly prostatitis and benign prostatic hyperplasia . There is no evidence that either condition leads to prostate cancer, but someone can have one or both of these conditions and develop prostate cancer as well.

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    What Is It Used For

    A PSA test is used to screen for prostate cancer. Screening is a test that looks for a disease, such as cancer, in its early stages, when itâs most treatable. Leading health organizations, such as the American Cancer Society and the Centers for Disease Control and Prevention , disagree on recommendations for using the PSA test for cancer screening. Reasons for disagreement include:

    • Most types of prostate cancer grow very slowly. It can take decades before any symptoms show up.
    • Treatment of slow-growing prostate cancer is often unnecessary. Many men with the disease live long, healthy lives without ever knowing they had cancer.
    • Treatment can cause major side effects, including erectile dysfunction and urinary incontinence.
    • Fast-growing prostate cancer is less common, but more serious and often life-threatening. Age, family history, and other factors can put you at higher risk. But the PSA test alone canât tell the difference between slow- and fast-growing prostate cancer.

    To find out if PSA testing is right for you, talk to your health care provider.

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    Side Effects Of Treatment

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

    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.

    Read more about managing the side effects of prostate cancer treatment.

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