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Prostate Cancer

PSA Level of 1.94 After Prostate Removal

02/07/2008

Question:

I recently had my prostate removed. My PSA (Prostate-Specific Antigen) level after removal was 1.94. Before removal it was 39. I am scheduled for radiation treatments and hormone therapy, however, is this PSA level of 1.94 really bad?

Answer:

I assume that your workup before the surgery with a CT scan and Bone scan was negative for metastatic disease (cancer spread outside the prostate) and that your post-op PSA has been drawn more than 6 weeks after the procedure. Given this, the decision to proceed with adjuvant therapy (radiation, hormone) after surgery would depend on a number of factors including the pathology report of the pre-operative prostate biospy as well as the surgical specimen (grade of disease, whether the cancer is outside the prostate gland, involvement of lymph nodes), PSA (pre-op and post-op) and clinical situation of the patient. A detectable PSA of 1.94 could mean some minimal amount of residual disease or involvement outside the prostate. It has dropped down though from a pre-op value of 39, which is encouraging.

As I mentioned above, this value of 1.94 would need to be evaluated in the context of the other factors such as the pathologic grade and stage of the disease. A situation as yours would usually require some form of adjuvant therapy (as you have been advised), with the exact treatment plan being determined by the individual clinical situation. The other option (less common in this situation), would be to monitor the PSA without any immediate adjuvant therapy (again based on your clinical situation and after discussion with your urologist).

It would be important to monitor the follow up PSA values after initiating the adjuvant therapy, as the PSA trend over a period of time is more informative than just a single value. In summary, your PSA drop from 39 to 1.94, though not ideal is still encouraging but would possibly warrant some form of adjuvant therapy based on the clinical situation, with a good possibility of response which would be monitored with serial PSA measurements.

I hope my answer provides you with reasonable information to help you in discussing your treatment plan and options with your treating physician, based on your actual clinical circumstances.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati