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…..