A 62-year-old patient had surgery to remove his cancerous prostate gland about 6 years ago. Two years after surgery his PSA started to rise and now his PSA is 4.6 ng/ml.
I hate to say it but, it is clear that this patient has failed surgery and has "biochemical failure." In other words, his prostate was removed but there is something in his body making his PSA go up and probably more cancerous cells in his body. Even though he feels fine, this rise in PSA is the only sign that his prostate cancer is trying to return. There are two places were cancer can return: 1) in the pelvis where the prostate used to be located, or 2) elsewhere in the body, suggesting that the cancer has spread. Unfortunately, this is a fairly common problem. Up to 30% of men will not be cured by surgery alone and they will have a rise in their PSA months or years after the prostate is removed. That is why it is crucial for men to have their PSA checked on a regular basis after treatment.
There are f...
Dear Dr. Motola,
If a person has a low PSA can you attribute this to any particular factor or factors? In other words are there any medical reasons for a low PSA? A friend told me that there has to be mitigating factors for this low score.
A low PSA is usually desirable as it will be associated with a lower likelihood of prostate cancer . Prostate cancer is not always associated with an elevated PSA as tumors that are very high grade may be associated with normal PSA . This occurs because high-grade tumors are very dissimilar to normal prostate, and as a result lose their ability to secrete PSA. Most often these patients will have very abnormal digital rectal examination. Patients taking Proscar or Avodart may often have low PSA values. This group of patients needs to have careful scrutiny of the interpretation of their PSA.
At What Age Should I Start Getting PSA Tests? The age at which one should first have a prostate cancer screening has been debated. The recommendations of the American Cancer Society are for all patients over the age of 50 to undergo digital rectal examination and PSA testing . However, few weeks go by in the office without a patient under the age of 30 who requests a prostate cancer screening. Using 50 as an arbitrary age cut-off is subject to much discussion. Patients who are at high risk for prostate cancer – such as African-American men or those with a strong family history of a father or brother who were diagnosed with prostate cancer prior to age 65 – should begin screening at age 45. Prostate cancer is the second leading cause of cancer death in African-American males. African-American males have a 60% higher incidence of prostate cancer as well as a higher death rate from prostate cancer than white males – 64% vs. 26.2% according t...
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