prostate cancer checkup + elevated PSA reading - ?

A very close friend was diagnosed with prostate cancer about a year ago. His prostate was removed and he had localized radiation. Today he had a checkup and just emailed me this:

“my doctor took great pains to remind me “you’re not dying.” What did happen is my PSA rose somewhat, from near zero to 1.8. While that’s not that high for normal cases, since I’ve had prostate removal it shouldn’t even be that high. So… I am back on hormones-- I had an injection today, and I’ll be taking daily pills as well. I’ll have everything re-checked in 4 months, and my doctor is pretty confident that the hormone treatments are going to cut into that PSA level. But, this could be a permanent thing, with injections on a regular basis and probably medication as well. In the meantime, I am going to be meeting with an oncologist, just on a consulting basis, and I am also going to have bone and CT scans just to make sure that the cells are still fairly localized.”

He is not a person who looks for more info or detail and generally trusts the doctors to make all the decisions. Which is his choice, but I am wondering does anyone have any more info on what that elevated reading could mean? Is it worse than the doctor made it sound? Better?

Any info much appreciated!

I recall reading recently that elevated PSA level is actually a poor indicator of prostate cancer. Something about it leading to unnecessary prostatectomies where no cancer was actually present.

Can’t back that up with a cite, maybe someone else is famliar with it.

Doctors should now point out that PSA is now considered an unreliable indicator. An elevated level can be caused by many factors, and there is no need for concern unless a continual rise is seen over a period of time. Other indications of prostate cancer or BPH are better detected through other means. Unfortunately one of those means is a digital exam.

Whoa, what?? I need mroe info on this, any cites and links would be great. When he had his prostate removed less than a year ago, he had been full-body scanned etc., he had elevated PSA and did have a rectal exam before the eleevated PSA that IIRC didn’t indicate any issues. Full body scan showed nothing anywhere else in the body.

Without a prostate, what could be causing PSA levels to rise?

Here’s the Cancer Institute’s take on it. There’s a lot of info out there if you look for it.

PSA is found outside of the prostate, but in pretty small quantities that it should be undetectable in a man without a prostate. Technically any epithelial cell can produce it, but most don’t.

My first inclination is to believe that not all the abnormal/cancerous prostate cells were removed and that there are some abnormal prostate cells that remain in the body and caused the “elevated” PSA.

But the thing is, his prostate has been removed. In that case, any detectable PSA is a concern.

Given that his prostate has been removed, the presence of a significant level of PSA likely does indicate that he still has cancer. However, not all cancers are alike, and a great many of them are so slow-growing that they won’t kill you before you would have died of something else anyway. So even if your friend does have cancer, it’s not necessarily something he should worry about. He should be getting regular checkups just in case it does turn into a problem, but it might not.

If his prostate was removed and he had subsequent radiation therapy, he must’ve had an aggressive form, and any cancer cells that were missed and not destroyed by radiation will be of the same type. As Minnie Luna posted, he should have no detectable PSA, and the fact that he does, and it is not miniscule, is alarming. Is it worse or better than his doctors tell him? I think the doctors are telling him the truth.

Not necessarily, his doctor may have been in the “better safe than sorry” school.

I had slowly growing PSA levels over a couple of years, so I went to a specialist (urologist) for an examination. He did a thorough (!) digital exam and found a slight abnormality in one of the lobes, which by itself would not have caused further action, but combined with the PSA levels was enough (in his opinion) to justify a biopsy. (came out negative, thankfully)

One of the questions I asked was whether, if there were cancer, he would be able to tell whether it was aggressive or not. He said he couldn’t tell from the biopsy (but I think he said there might be other ways, including just continuing to monitor it every couple of months or so).

Research seems to support the idea that PSA can come from other causes than prostate cancer. There seems to be a new urine test that can supposedly tell whether the PSA comes from cancer or not; I don’t know how widely available or how expensive this test might be yet.

If he is going to be consulting an oncologist, I would tend to go with that doctor’s recommendation, but I would want to make sure he is up on the latest research on PSA and cancer.
Roddy

First of all, the case the OP mentions is NOT prostate cancer screening, but follow-up of prostate cancer. Here, PSA is very important, for reasons a number of posters have noted.

To summarize the general situation, I quote uptodate.com, a paid subscription website:

What does that mean? It means it helps to know the status of the cancer at the time of surgery/radiation/other intervention. Then it helps to follow just how fast the PSA is rising. This data can guide the oncologist to see if the patient needs extensive scanning to look for recurrences, and to biopsy them if found.

It’s a complex decision tree that requires a lot of technical info to figure out where to go next.

Thank you again for the responses - I’m talking to my friend tonight and will ask him for more specific info. I can tell you that the PSA level post surgery and radiation was never as low as the oncologist had wanted to see it - it was very low, but he would have preferred it lower. I will try to get numbers. Also, the cancer had not spread at the time of discovery. His doctor has stated repeatedly he is a ‘better safe than sorry’ type doctor, so there is that, but my friend is also pretty old school about this and seems content to elave this entirely in the hands of the emdical professionals. As you can see, I know very little, but I know a lot more than he does. I suspect it may have been a choice he made consciously, being anxiety-prone, maybe he didn’t want to drive himself nuts with waht-ifs on Google.

Will try to get back for more info. As I said, the surgery was about a year ago now, and the radiation treatment ended in late 2011 - this was his first checkup since the major battle (surgery + followup radiation) was waged.

Absolutely right, but as I said, there’s a big difference between a man who still has a prostate, and one who has had his prostate removed, in terms of what the PSA levels mean. In general terms a low-to-normal PSA for a man with a normal prostate would be dangerously high for a man without a prostate.

A PSA test is a good indicator you may need a biopsy, not a prostatectomy.

What is the downside of having a prostatectomy?

I mean, since so many older males have prostate trouble of one sort or another, why not just do a total prostatectomy (ETA: or at least offer the option) on ALL males at the FIRST hint of any problem, and save them all the hassle and horror that may come later? Is there some reason an older male needs a prostate? Is a prostatectomy an especially complicated or expensive operation?

Why even wait? Why not give any male, age 60 or older, the option to have a completely proactive prostatectomy on request?

My father has been going through the say thing…there’s a thread out there about it.
He had his prostate removed last year, after the biopsy gave a Gleason score of 8. His PSA was elevated a few months later, and has been on hormone therapy. That knocked it back down, but we were told it was considered a temporary measure. He is likely to undergo radiation therapy in the not-to-distant future.

According to the literature I’ve found, this isn’t really uncommon. In my Dad’s case, there was lots of scaring and fibrosis in the area from past injuries, and it was a very difficult surgery. We suspect that it’s just a little cancer left, and will have to be dealt with appropriately.

Best wishes for your friend!

-D/a

Significant risk of erectile dysfunction.

There’s a small but solid chance of needing a catheter & bag to pee the rest of your life. And, it requires a general, and there’s always a chance you won;t wake up from one of those.

One major point- if you are say 70 and it’s discovered, it’s often better to do nothing just watch and wait. It can take 10 years before it gets really bad.

Does nobody read these threads? We’re talking about a man who already has no prostate to be biopsied or removed.

Yes, of course. But oft-times the threads turn into general advice and questions, such as this thread has.