PSA is a protein produced by both normal and cancerous cells in the prostate. After a prostatectomy, PSA levels in your blood should fall to undetectable levels within six to eight weeks. Your doctor will want you to have a PSA test at that time.
While PSA isn’t always reliable when it comes to general cancer screening, it’s an effective indicator of cancer recurrence. A high or rising PSA level could mean cancer cells are still circulating in your body. Learn more about PSA levels and prostate cancer.
Continue reading to learn why the PSA test must be repeated and how your doctor will determine the next steps.
PSA tests can be difficult to interpret. Tests can also vary from laboratory to laboratory. To ensure accurate comparison, it’s important to use the same lab each time you’re tested.
If your PSA level is low and not rising after repeated tests, it’s probably not a cancer recurrence. That’s because other cells in your body can produce small amounts of PSA.
Ideally, your post-prostatectomy PSA will be undetectable, or less than 0.05 or 0.1 nanograms of PSA per milliliter of blood (ng/mL). If that’s the case, your doctor may call it a remission.
If the result is greater than or equal to 0.2 ng/mL and it’s risen on two separate tests taken at least two weeks apart, it’s called a biochemical relapse. You still have PSA in your bloodstream. There’s a chance that cancer has recurred.
A PSA level higher than that may indicate a locally advanced tumor.
After prostatectomy, you’ll probably have a PSA test in about six weeks or so. Your doctor will recommend a follow-up schedule, usually every three months for two years. Depending on the results, you may need to test once or twice a year thereafter. Testing may be more frequent if it appears to be rising.
If your PSA levels are high and you have symptoms such as bone pain, imaging tests can be used to determine if cancer has spread. These may include bone scans and CT scans. If a mass is found, a biopsy can determine if it’s cancerous.
You might not need treatment right away. If you’ve had multiple PSA tests and it appears that your PSA level is rising, a number of other factors determine the next steps. These factors include:
- age and life expectancy
- general health
- cancer grade and aggressiveness
- if cancer has spread and where
- previous treatments
Radiation therapy after prostatectomy, also known as salvage radiotherapy, can be quite effective after a prostatectomy. External beam radiation can be delivered directly to the area around where the prostate was. The goal is to destroy prostate cells that may have been left behind after surgery. This lowers the risk of recurrence and metastasis, or of the cancer spreading.
Metastatic prostate cancer may not be curable, but there are treatments to slow progression and manage symptoms. Treatments may include:
- radiation to target a particular tumor
- hormone treatment to lower testosterone levels
- systemic chemotherapy to destroy cancer cells anywhere in the body
- medications to manage pain
Prostate cancer is often curable with surgery and radiation therapy.
According to Cancer Research UK, about 1 in 3 men with early-stage prostate cancer have a recurrence after treatment. If it does recur, it can be treated.
The five-year relative survival rate for prostate cancer that hasn’t spread outside the prostate — or has spread only to nearby lymph nodes — is almost 100 percent, according to the American Cancer Society. For prostate cancer that has spread to distant areas of the body, the five-year relative survival rate is about 29 percent.
Your doctor will be able to provide you with some idea of what to expect based on your personal health profile.
When it comes to cancer recurrence, there are no guarantees. But there are things you can do to lower your risk and improve your overall health.
If you smoke, quit now. According to the Prostate Cancer Foundation, men who have a prostatectomy for localized prostate cancer and continue to smoke are twice as likely to have a recurrence. Men who quit smoking have a risk similar to those who never smoked. Smoking is also a risk factor for prostate cancer death.
Managing your weight may also help. Obesity is associated with more aggressive disease and death from prostate cancer. Whether you only have a few pounds or many pounds to lose, slow and steady weight loss can start today.
Even if your current weight is in a healthy zone, eating right can help keep you there. Here are a few tips to get started:
- Avoid or minimize saturated fats. They may increase the risk of recurrence. Limit red meat and processed meat.
- Have at least two and a half cups of vegetables and fruits a day.
- Choose whole grains over refined grains and sugars.
- Avoid alcohol, or stop at two drinks a day. Alcohol may raise the risk of cancer.
- Skip fad diets and promises of quick weight loss. If you have a lot of weight to lose, consider working with a dietician.
- Engage in regular physical activity. If you’re still in treatment, talk to your doctor before starting a new exercise program.]
See your doctor regularly, have follow-up testing as advised, and report new symptoms right away to improve your outlook.