Post prostatectomy: What do rising PSA levels mean?

Posted by hoard @hoard, Sep 10, 2019

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 https://www.medicalnewstoday.com/articles/323899.php

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
– medication
A 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."

The PSA test alone is not enough to determine cause or next steps. Your doctor will likely consult with your husband and possibly order other tests. How long ago did your husband have his surgery? Did he have other treatments after surgery? Do you have a followup appointment schedule with his oncologist?

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

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@gcoley

I had a radical prostectomy in 2006. For the first 12-years after surgery, my psa was 0.01. A year ago it was 0.02. This year it was 0.1. My family physician didn't seem concerned. However, this rise has me concerned. After 14-years, is my cancer returning? What actions, if any, should I take?

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Hello @gcoley, Welcome to Mayo Clinic Connect. I can understand your concern and concern can be a good thing. Here's some information that may help understand the testing and followup.

Prostrate Cancer Foundation: https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/
Following PSA Levels During and After Prostate Cancer Treatment: https://www.cancer.org/cancer/prostate-cancer/treating/psa-levels-after-treatment.html

You mentioned your family physician didn't seem concerned. Are you able to ask the surgeon who performed the procedure about the rise in the PSA test numbers?

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@johnbishop

Hello @gcoley, Welcome to Mayo Clinic Connect. I can understand your concern and concern can be a good thing. Here's some information that may help understand the testing and followup.

Prostrate Cancer Foundation: https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/
Following PSA Levels During and After Prostate Cancer Treatment: https://www.cancer.org/cancer/prostate-cancer/treating/psa-levels-after-treatment.html

You mentioned your family physician didn't seem concerned. Are you able to ask the surgeon who performed the procedure about the rise in the PSA test numbers?

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My surgeon retired 5 years ago. Thanks for the information.

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I had a radical prostectomy in 2006. For the first 12-years after surgery, my psa was 0.01. A year ago it was 0.02. This year it was 0.1. My family physician didn't seem concerned. However, this rise has me concerned. After 14-years, is my cancer returning? What actions, if any, should I take?

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@gcoley

I had a radical prostectomy in 2006. For the first 12-years after surgery, my psa was 0.01. A year ago it was 0.02. This year it was 0.1. My family physician didn't seem concerned. However, this rise has me concerned. After 14-years, is my cancer returning? What actions, if any, should I take?

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I add my welcome @gcoley. You'll notice that I moved your message to an existing discussion where @hoard asked a similar question about rising PSA levels after a prostectomy. Please click VIEW & REPLY to scroll through previous posts. Allow me to repost info that I posted for @hoard

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 https://www.medicalnewstoday.com/articles/323899.php

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
– medication
A 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."

The PSA test alone is not enough to determine cause or next steps. Do you have a followup appointment schedule with your PCP or oncologist to discuss?

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Is an MRI of prostate effective to show stages?

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The MRI can assist in corroborating the extent to which the cancer has spread both within the prostate and possibly outside the capsule, helping to determine the course of treatment — surgery, radiation, ADG, etc. However, a prostate biopsy is required to determine the areas impacted by the cancer cells and the relative rate of "aggression" in each area. The biopsy results then provide Gleeson scores that are indicative of the cancer "rating" in each area, and are critical to the determination of how and where to treat the cancer within the prostate gland.

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Hoard,glad you all joined. Short answer: too many variables/patient. Recommend seeing your providers for the best, most reliable information for your husband. All the best…
Mike C.

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I have question regarding stage 3b prostrate cancer. In November of last year I was diagnosed with stage3b prostrate cancer. I was told that the cancer had not spread and that a radical prostectomy was all that was necessary. Everything I have read stated that stage3b has spread to some surrounding tissues. Just 6 months later I’m told that the cancer has metastasized and spread. My question is this. Should radiation and/or hormone treatments have been advised before the cancer went to stage 4? Thanks for any information.

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@numnuts

I have question regarding stage 3b prostrate cancer. In November of last year I was diagnosed with stage3b prostrate cancer. I was told that the cancer had not spread and that a radical prostectomy was all that was necessary. Everything I have read stated that stage3b has spread to some surrounding tissues. Just 6 months later I’m told that the cancer has metastasized and spread. My question is this. Should radiation and/or hormone treatments have been advised before the cancer went to stage 4? Thanks for any information.

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Hello @numnuts, Welcome to Mayo Clinic Connect. I see that you also posted the same question in the Stage3b Prostrate cancer discussion. I'm not sure anyone can answer your question as we are not medical professionals or doctors. I did find some information on the American Cancer Society website that may be helpful for you.

Initial Treatment of Prostate Cancer, by Stage: https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html

Have you started a new treatment?

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@numnuts

I have question regarding stage 3b prostrate cancer. In November of last year I was diagnosed with stage3b prostrate cancer. I was told that the cancer had not spread and that a radical prostectomy was all that was necessary. Everything I have read stated that stage3b has spread to some surrounding tissues. Just 6 months later I’m told that the cancer has metastasized and spread. My question is this. Should radiation and/or hormone treatments have been advised before the cancer went to stage 4? Thanks for any information.

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I am surprised they did not start hormone therapy. That is pretty standard whether you decide to go with radiation or surgery is my opinion. I started ADT hormone therapy as soon as my cancer was staged.

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New Prostate Cancer Patient. Had my Prostatectomy 3/3/20. On 4/20/20 my PSA was 0.068. Today 7/23/20 my PSA test 0.127. My Dr wants me to consider Radiation Therapy to prevent possible spread. Should I wait until PSA is above 0.2.

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You should check those PSA numbers. My number is currently undetectable (4 yrs post surgery) and is quoted as <0.10ng/ml. This is the lower limit of detection of the test. Your 0.068 and 0.127 numbers may not be different and could both be at the lower limit. It is not a good idea to start radiation until you are sure of the need for it since it can have significant side effects. Also, I recall that PSA has a fairly long half life and it takes about 8-10 weeks to get a reliable number while the amount already in the blood decays. I'm not sure of the half life but your doctor should know and then you can do a simple calculation based on your pre-op PSA number to see when it should be undetectable.

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@brownhome1

New Prostate Cancer Patient. Had my Prostatectomy 3/3/20. On 4/20/20 my PSA was 0.068. Today 7/23/20 my PSA test 0.127. My Dr wants me to consider Radiation Therapy to prevent possible spread. Should I wait until PSA is above 0.2.

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Hello @brownhome1, I would like to add my welcome to Connect along with @horace1818. Here's some information I found that I hope may be helpful.

Excerpt from link below…"After the surgical removal of the prostate, or prostatectomy, PSA drops to virtually undetectable levels, (less than 0.1), depending on the lab performing the PSA test. … Following a prostatectomy, the most widely accepted definition of a recurrence is a confirmed PSA level ≥0.2 ng/mL."

Is Your PSA Rising? | Prostate Cancer Foundation: https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/psa-rising/

You mentioned your doctor wants you to consider radiation therapy. Are you able to discuss your concerns with the doctor about waiting to see if the PSA goes higher?

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