Rising PSA after Surgery
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 few ways to evaluate this situation. The first is to perform a CT scan of the abdomen and pelvis to see if the cancer is in the other organs or lymph nodes. The second is to perform a nuclear bone scan to see if the cancer has spread to the bones. A third is a prostascint scan which is a nuclear scan of the entire body to locate early signs of prostate cancer in other organs. A prostascint scan is not very reliable and may only give a true positive result in 60% of cases.
Once these studies are completed, treatment can be recommended. If the urologist feels that the cancer is returning just in the pelvis where the prostate gland used to be, then a course of external beam radiation therapy to the “prostate bed” is warranted (this is called “salvage radiation”). Sometimes the patient will be given a course of hormone injections (called LHRH agonists) to stop the production of testosterone in the body while they are undergoing radiation. Remember, prostate cancer requires testosterone to grow. However, if the urologist feels that the prostate cancer has spread to the lymph nodes or other organs, then LHRH agonists will be started to stun the growth of the cancerous cells producing the PSA. This will cause the cells to shrink and stop producing PSA. Hopefully, these options will control the cancer for a very long time.
Let’s wish this patient well.
Marc Greenstein is a practicing urologist in New Jersey. He wrote for HealthCentral as a health professional for Prostate.