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What Is A Normal Psa Level After Prostate Removal

What Is A Radical Prostatectomy

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

Surgery to remove the prostate to treat prostate cancer is called a radical prostatectomy. The aim of surgery is to remove all of the cancer cells.

It is usually done when the cancer is contained in the prostate and has not spread to the surrounding area.

A prostatectomy may sometimes be done to treat locally advanced prostate cancer. But usually, this operation is not possible. This is because the surgeon would not be able to remove all the cancer cells that have spread outside the prostate. Other types of surgery, such as transurethral resection of the prostate , can help with the symptoms of locally advanced prostate cancer.

A prostatectomy is a big operation and may not be suitable for everyone. Your doctor can tell you whether it is suitable or if a different treatment may be best for you.

See also

How Are Researchers Trying To Improve The Psa Test

Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include

Selected References
  • Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004 350:22392246.

  • 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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    What Causes An Elevated Psa Level

    Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a persons PSA level include:

    Your healthcare provider will also consider whether your medications affect PSA levels. For example, 5-alpha reductase blockers treat enlarged prostates and will lower PSA levels.

    What Is Considered Rising Psa After Prostatectomy

    Incremental value of magnetic resonance imaging in the advanced ...

    After radical prostatectomy, it takes the PSA quantities in patients blood to drop to undetectable levels in four to eight weeks. Within this timeframe, the doctors will perform the first PSA test after prostatectomy in order to determine whether there are any signs left of prostate cancer.

    So, the question is: Can you have a PSA reading after the surgical removal of the prostate gland? Since PSA is a type of protein produced only by prostate cells and prostate cancer cells, when you eliminate one of the two sources of PSA, any trace of PSA presence can indicate the only source left: a prostate tumor.

    This usually happens when the tumor is advanced at the time of surgery and could have already spread its cancer cells to other parts of the body.

    It is considered elevated PSA after prostatectomy a PSA greater than 0.2 ng/ml. If the prostate cells are grown enough to generate detectable levels of PSA, this could be an alarming point both for the patient and the doctor.

    It is important to note that a 0.2 ng/ml level of PSA is not alarming when first diagnosed with prostate cancer. Thats because the prostate gland generates a certain level of PSA by itself, even in healthy men. However, the same reading becomes a reason for concern after a radical removal of the prostate gland. The PSA level after prostatectomy is expected to be zero or at undetectable levels unless the prostate cancer cells had already spread to other parts of the body.

    Recommended Reading: Metastatic Hormone Sensitive Prostate Cancer

    What Should You Know About Psa Levels

    Under normal circumstances, the serum secretions of PSA should stay under 4 nanograms per milliliter . People who have prostate malignancy usually have high PSA levels, but low or normal PSA doesnt always mean that the person is cancer-free. A smaller number of men with prostate cancer have low or normal PSA levels. This suggests that PSA test by itself is not a confirmatory test but can help in identifying who might be at risk of developing the cancer or has developed the malignancy.

    Usually PSA test is preceded or coupled by DRE , in which the examiner inserts the finger in patients rectum to check for the consistency or edges of prostate gland. At risk patients with abnormal findings on the DRE and high PSA levels are subjected to biopsy to ascertain the cause and confirm the diagnosis. It is imperative to mention that False-Positives are common.

    High PSA Levels without Prostate Cancer:

    Testing errors such as mishandling of sample, measuring inconsistency, lifestyle choices and overall physical health can alter with PSA levels. Following are some physiological causes of high PSA levels.

    References:

    Considerations When Opting For Surgery

    Before agreeing with any surgery, knowing its benefits and risks is vital. It is even more important when the surgery is not urgent, like in the cases of proctectomy.

    Thus, one should ask a doctor about various treatment options, prostate surgery recovery, and what to expect after prostate surgery.

    Sometimes prostate surgery is one of the options. Thus, it is important to ask a doctor if it would be better to have some watchful waiting.

    If one goes for prostate removal, one should know about the benefits, prostate surgery complications, the side effects of living without a prostate, how long prostate cancer surgery is, its impact on sex life, etc.

    Additionally, one should inquire about all the surgical options available and consider the risk and benefits of each of the options.

    Quite often, doctors may also help in making the decision. Here good communication with a healthcare provider is the key.

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    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
  • Low detectable, stable 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:

    What Are The Side Effects Of Prostate Cancer Surgery

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

    People often ask what happens if the prostate is removed? What to expect after prostate surgery? And can you have your prostate removed at all? The answer is yes it is possible to have the prostate removed.

    Life without a prostate can be close to normal for some, though not free from the after effects of prostate removal.

    There are few prostate surgery complications. Some are acute, and others chronic. Among acute side effects could be a reaction to anesthesia, bleeding issues, blood clots in legs, damage to nearby organs, and infection at the surgery site.

    However, in most cases, people are interested in life after prostate removal, the pain after prostate surgery, and the long-term after effects of a prostatectomy.

    There are two main side effects of prostate surgery. These are urinary incontinence and erectile dysfunction.

    Recommended Reading: Where Does Prostate Cancer Metastasis To First

    What Happens At A Follow

    Discussion with your doctor or nurse

    At each appointment, your doctor or nurse will ask how youve been since your last appointment.

    Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.

    Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.

    You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.

    PSA test

    You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.

    Other Key Findings In The Study

    Patients who had lower PSA scores:

    • Experienced an eight-year disease-free survival rate of 75 percent, compared with only 18 percent for those with the highest PSA scores.
    • Had a 97 percent distant metastasis-free survival rate, compared with 73 percent for those with the highest PSA scores.

    However, the study also indicated that, when a PSA is falling, there is no specific number that predicts future survivability.

    While there is no magic number for the PSA that guarantees that prostate cancer has been cured in an individual patient, in general, the lower the PSA number, the better chances that the cancer will not return or spread, said Michael E. Ray, M.D., Ph.D., lead author of the study and a radiation oncologist at the University of Michigan Medical Center.

    Read Also: Odds Of Getting Prostate Cancer

    When To Get Tested

    You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.

    Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.

    Making An Informed Decision

    Surviving Prostate Cancer: My Story

    There are many things to consider when agreeing to proctectomy. Thus, one should ask healthcare providers various questions, from the cost of prostate cancer surgery to prostate cancer surgery after side effects.

    During appointments or doctor visits, take more interest in prostate cancer treatment medications, supplements, how the process is done, whether the doctor would consider hormone therapy, other treatment options, sex life after prostatectomy, diet after surgery, rehabilitation, and more.

    When agreeing to proctectomy, one should consider the risk and benefits and explore all non-surgical options. Once the prostate gland is removed, one will have to live with specific issues for a long.

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    Ways To Prevent Recurrence

    When it comes to cancer recurrence, there are no guarantees. But there are things you can do to lower your risk and improve your overall health.

    If you smoke, quit now. According to the Prostate Cancer Foundation, men who have a prostatectomy for localized prostate cancer and continue to smoke are twice as likely to have a recurrence. Men who quit smoking have a risk similar to those who never smoked. Smoking is also a risk factor for prostate cancer death.

    Managing your weight may also help. Obesity is associated with more aggressive disease and death from prostate cancer. Whether you only have a few pounds or many pounds to lose, slow and steady weight loss can start today.

    Even if your current weight is in a healthy zone, eating right can help keep you there. Here are a few tips to get started:

    • Avoid or minimize saturated fats. They may

    Post Prostatectomy: What Do Rising Psa Levels Mean

    New to group! Wish I had checked this out 2 years ago while supporting my husband! Now over e years post prostatectomy, wondering what might make psa go from all 0 to 2.6

    Welcome to the Prostate Cancer group, @hoard.You ask a good question. What can rising PSA levels means years after having had a prostatectomy?There are several reasons why one’s PSA level may rise after being stable for a time. This article explains it well: PSA levels after prostatectomy

    Here’s an excerpt from the article:”Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels. Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.

    In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include: older age ethnicity medicationA doctor will take these factors and the person’s medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern.”

    Thank you! Relieves my mind somewhat! Next PSA in November.. long wait.

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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.

    Recommended Reading: Female Prostate Equivalent

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

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

    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.

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