What if my PSA comes back after surgery?

Making PSA sense After Treatment

What do you do if PSA comes back or never goes down after prostatectomy or radiation therapy?

I recently interviewed Weill Cornell Medicine urologist Jim C. Hu, MD, MPH, about this topic for the Prostate Cancer Foundation website. Jim Hu’s expert tips are also featured in ours book.

Before we begin, listen to these words: “If your PSA rises after surgery or radiation therapy, don’t panic!” says Hu. “It’s not a death sentence. You just have to do something.” And the first thing we need to do, he says, is find out exactly what’s going on.

Also: If you’ve had a prostatectomy and your PSA is undetectable, that’s great – but don’t stop checking it. “Some men might think, ‘My surgery is over, I got my progress report, there are negative margins, so that means there’s no cancer,'” says Hu. And often, that’s true. “I’ve seen cases where men get off the wagon and don’t get follow-up PSAs for a few years.” But he may not be out of the woods. Of the men who do develop PSA recurrence after prostatectomy, 50 percent experience it more than three years after surgery and 70 percent have it within five years. In other words, most recurrences occur within 5 years after surgery. After 10 years, the risk of PSA recurrence becomes very low – but still possible, which is why many urologists advise their patients to continue to have their PSA checked for decades.

Quick note: If you had focal treatmentand your PSA is rising, now is the time to have a surveillance biopsy and consider treating the entire gland. This is determined on a case-by-case basis. consult your doctor.

After surgery, how often should you check your PSA?

This varies. Your urologist may recommend that you get it checked every three months for the first five years if you are in higher risk (recurrence): if you had positive surgical margins, or sperm infiltration or lymph node involvement N1 or high-grade (Grade Group 4 or 5, Gleason 8, 9 or 10) cancer or pathological stage of T3b.

If you are not at high risk, your urologist may recommend quarterly screening for the first two years after surgery, then move to every six months and then annually. “The guidelines were to be tested every six months for the first five years and then annually,” Hu notes, but some doctors are moving to an annual PSA earlier.

Why not get a PSA test right after surgery?

Like a bad party guest, PSA doesn’t leave when you want it to. It remains in the bloodstream for a while, even after the prostate is removed. “It usually takes about two months for PSA to wash out of the bloodstream,” says Hu. “So you should never receive the first PSA earlier than two months. There can be a false positive” because some PSA is still lingering, taking its sweet time to disappear. That the PSA is an artifact. a marker for something that no longer exists – but can be upsetting to look at. So “three months is usually the soonest you should check it out.”

Should you get a highly sensitive PSA test?

Again, this is up to your doctor – and you too. Some national laboratories, such as Quest, perform tests that can detect PSA as low as 0.02 ng/ml, and others, such as Labcorp, can show PSA as low as 0.006 ng/ml. “Some men just want to know as precisely as possible,” says Hu. “I know doctors who don’t like to order hypersensitivity tests because that first test can be a little higher and that causes anxiety for the patient. Also, if the PSA is less than 0.1 but not lower than 0.02 or 0.006, the patient may be concerned.” The very low number is actually very low to be active. “Highly sensitive PSAs can be a double-edged sword,” Hu continues. “There is research that shows that if your first PSA after surgery is less than 0.03, then there is a reduced risk of recurrence. Some people do the highly sensitive test because they want that reassurance.”

Next, Part 2: What PSA number should ring the call to action?