PSA Level after Prostate Cancer Surgery – Fluctuations and Rising and Falling

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One of the many tests that are carried out in the course of diagnosing and staging a patient for prostate cancer, PSA test is the test for the level of prostate specific antigens in the blood of the patient. All men have a PSA reading that is rarely ever higher than 4ng/ml when they are in good health; when they are suffering from any form of disorder to the prostate though, this level rises above the 4 point mark and it is immediately apparent in a blood test.

However, there are a lot of diseases that do affect the prostate gland, so prior to confirming that it is indeed prostate cancer that the patient is suffering from, it could well also be a benign prostate hypertrophy (BPH), a noncancerous condition of unknown cause; bacterial or nonbacterial prostatitis, an inflammatory condition of the prostate; or prostate cancer, most common in elderly men. Many of the symptoms of the disorder even further complicate the diagnosis because they are generally similar, hence the need for a biopsy.

After accurate staging of the cancer is done, treatment is effected in which whatever can be done to slow or halt the progress of the cancer is administered first (unless the disease is still in the very early stages, in which case that might be unnecessary), and then treatment to kill the malignancy or have it removed from the body by surgery. Most early cases of prostate cancer are often cured in this way giving an impressive 10 year biochemical disease free rate.

But then, there are cases of rising and falling of PSA levels after a prostate cancer surgery, which may precipitate confusion for the patient and bewilderment even for the overseeing oncologist. Actually, the PSA for a patient who has just undergone a radical prostatectomy should rapidly drop to 0, the aforementioned anomaly could occur as the disease has been inaccurately staged or if it turns out to be an aggressive or recurring form of prostate cancer.

Often, hormonal therapy is used to slow the progression of such tumors ? even reverse them ? but hormonal treatments don’t cure prostate cancer. Even though another surgery may be in view, radiation therapy is often attempted first because it has become more precise in recent times, and many consider it to be less risky and invasive than prostatectomy. Of late, investigations have been looking into how late stage prostate cancer can be helped by cryotherapy, which is largely still an early stage procedure; but the best treatments for rising PSA after prior treatments remain chemotherapy.

In the case of a PSA-only relapse, the most common form of advanced prostate cancer today, aggressive salvage therapy aimed at cure is called for. They are modestly effective, especially when administered early to men at low risk; but they are less effective for men who suffer from more aggressive disease. If the local salvage therapies fail, hormonal therapy is again used as early as possible in a very aggressive format hormonal therapy, especially for men with high-risk prostate malignancy. It does delay metastasis and appears to improve survival, although unproven. But for with secondary PSA-only recurrence after a failed hormone treatment, nonmetastatic hormone refractory prostate cancer often results, which may once again require chemotherapy, or may have to be managed by active surveillance.

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