The PSA is variable when used in the diagnosis of prostate cancer. It can be low and someone have cancer, it can be high and not have cancer. It can go down with antibiotics and a person could still have cancer (this happened to me). So the use of the PSA in the diagnosis is variable and why all the fuss about screening and its usefulness.
However, when it comes to recurrence of disease….it is very accurate. In the above question, the first thing to do is to repeat the PSA. If it is still high then that means there is prostate cancer somewhere.
The most common area is local or the bed of where the prostate was removed. After that bone and lymph nodes are common locations.
In the above question…the patient may have waited too long between PSA’s thinking that if it had been over ten years all must be well.
So the answer is that probably the cancer is back and he’ll need a CT and Bone scan to prove it is not in lymph nodes or bone. If not he may be a candidate for radiation to the pelvis and or hormonal therapy.
I had a patient recently who I took out his prostate about five years ago. He quit coming to see me opting instead for follow-up with his family doctor.
This patient would get a PSA and be told it was “normal.” By the time he made it back to me his PSA was over 5. He said, “My doctor wants me to see you because my PSA is now abnormal.”
After the prostate cancer has been treated the PSA should go to zero or so and stay there. For radiation, less than .5 , if surgery less than .05.
Normal after therapy is not the normal before. I advise my patients to stick with me on the follow-up because I will be sensitive to changes in the PSA that are “normal” in the pre treated prostate, but way “abnormal” in the treated prostate. Doctors look at a lot of labs daily and at a lot of patients labs. The post treated prostate cancer PSA of 2 will be marked as normal by the lab company, but in this case represents the recurrence of prostate cancer. Just a little caveat to know.
One other thing that is demonstrated by the question…you would think that a prostate cancer would be “cured” if the PSA was negligible at 5 years. Recent studies have shown you really have to be out about 10 years to make that statement. The above question suggests that in some it might be longer…..
Prostate Diaries 
Hi John
I found that really interesting as it is an area I have not (obviously) a lot of research. Although I have been doing my own research for 4 years.
I have always told my fellow PCa guys that they should have a CT and bone scan for recurrent PCa but I wasnt aware of the fact that anything over zero could, potentially be a problem.
It also highlights a problem I have raised a few times myself and that is the doctors (UK GP) lack of in depth knowledge of the PSA score and how to interpret the variations.
So thank you for that I will look for more information to fill that gap in my PCa journey.
My situation is that I was diagnosed in feb 2006 PSA of 125 biopsy gleason 9 non bony but metastatic. I had Zoladex implants and Zometa until Oct 2009 when I stopped both to give my body a break ( my PSA was undectable for the whole time). Over the last few months my PSA has started to rise 2.2 then 5.6 then 7.8 then 15.3 and now 54 (monthly increments) so I have decided to go back to hormone therapy. Of course I have had NO RT or surgery or chemo. Have you had experience of patients with similar results? (I will be 65 years old in 6 months).
I was also be interested in any opinion you might have around Active Surveillance for men whose regular PSA score does not rise above 20 and whose gleason score is 6. Currently in the UK men who present with a gleason 6 and PSA of between 5 and 10 are offered Active Surveillance but infinitely more emphasis put on surgery or RT combined with hormone therapy. Do you think that the overtreatment in PCa cases may too a large degree be down to the PSA and Gleason level that patients are referred onto a consultant? I know its not an exact science but we patients with a little or no knowledge of the subject are desperate for answers from professionals who seem just a confused as we are.
Keith
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Such a great post. So very true that PSA tests are an indication and PSA levels can change due to so many things. It should be thought of as a way to make men more aware of the possibility of developing prostate cancer, but should be stressed that it does not mean they definitely will.
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Had prostate and lymph nodes removed 11/09 at Mayo after gleason score of 3+4 7. Had psa checked the 7/24/11 showed .18 , told to check very month. Next .12 then less than pt one through Nov 4. Next check 1/9/12 and .14. What should I do now.
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the first thing you look at is doubling time and the time from the initial treatment and from that standpoint your numbers are encouraging. i asked a radiation therapist what was the ideal number of a psa to initiate radiation therapy for the prostatectomy patient with a rising psa… he told me .5 so….listen to your doctors and i like the monthly psa testing to determine a trend………….if you are lucky the psa rise is a small remnant of normal prostate tissue secreting a small amount of psa….. get a urologist you trust and listen to him and never any harm of a second opinion from your local radiation therapist….. i wish you the best jm
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