Making Peace with Rising PSA After Prostatectomy
The prostate produces PSA. And since both healthy and cancerous prostate cells manufacture PSA, a prostatectomy aims to remove the entire prostate. If successful, PSA should eventually drop to undetectable levels after surgery. Undetectable means PSA results are below the level the lab equipment can detect. Therefore, undetectable doesn’t necessarily mean zero. It just means that the value is below detectable.
The lab I use can measure PSA as low as 0.008. And if their equipment doesn’t detect PSA, the results are reported as less than 0.008. Or, in other words, undetectable.
Why it's critical to monitor PSA levels
After surgery, a rise in PSA to detectable levels may suggest there are prostate cells that survived treatment. It may be due to leftover prostate tissue, or cancer cells may have already escaped the prostate before treatment. Over time, these cells may multiply, spread, and produce even more PSA. And fast-rising PSA after surgery could be a sign cancer is still in the body.
The Prostate Cancer Foundation notes that prostate cancer recurrence, at least after surgery, is generally defined as when PSA rises to 0.2 ng/mL or above. Therefore, I think it’s critical to monitor PSA for life even if results remain undetectable, as cancer may resurface years after treatment.1
Monitoring after my prostatectomy
It’s now been five years since my prostatectomy. And for the first two years, I had a follow-up PSA every three months with consistent results of less than 0.008. Therefore, my PSA testing schedule changed from every three to six months for the following two years. Again, with consistent results of less than 0.008. A number that provided me with a great deal of comfort and a number that I expected to continue. However, that all changed at the four-year mark.
After four years of rock-solid undetectable results, it was quite a shock to see the less than sign disappear. I froze in a trance-like state, staring at the PSA results of 0.008. “Where is the less than sign?” I repeated over and over in my head. “It must be a mistake,” I thought. Therefore, I didn’t want to wait another three months for my next PSA test.
I immediately contacted my urologist, and to help ease my mind, he agreed to another test. And the results came back as less than 0.008. At first, I was elated to see the less than sign reappear, but three months later, my results were 0.012. I understand the results are still minuscule and perhaps insignificant. But after four consecutive years of undetectable results, it was a little unnerving to see a change.
Trying to get an explanation for my rise
So, I contacted a clinical biochemist at the lab, and she was more than happy to discuss the PSA test. She indicated that the lab equipment is ultra-sensitive and detects PSA at 0.008 with an acceptable error rate of 30%. That sounds high, but at that low level, results could vary by +/- 0.002. It was comforting to hear, but my results of 0.012 were beyond the acceptable error rate.
I then contacted my urologist, who indicated two possibilities for the slight rise. One: there are still healthy prostate cells that survived treatment. And if this is true, PSA levels would increase at such a slow rate the value would not likely reach recurrence level. The second reason could be that cancerous prostate cells survived treatment. If this is true, PSA can increase quickly, although it could take several years to reach recurrence. But to help ease my mind, my PSA testing schedule changed back to the original every three months.
Another change in the results
Over the next year, the results continued to change slightly, up and down, with readings of 0.010, 0.015, 0.013, and 0.015. But then something that I thought was very unusual occurred. Three months after the reading of 0.015, the results returned to 0.008! I couldn’t believe it. I’m back to 0.008!
Once again, I contacted my urologist and asked why my PSA might go down. He explained that it might be because a few prostate cells that survived treatment may have since died. But he also told me not to be concerned, as he has many other patients who also experience slight ups and downs in PSA. And it’s a pattern that he has observed for many years. Regardless of the reason for changing PSA, it felt incredible to see the results back at 0.008.
What my urologist told me
Although, that feeling went away three months later on the next follow-up PSA test. My level is now at the highest since surgery, with a reading of 0.017, as of my writing this. After another long talk with my urologist, he pointed out a couple of things that helped me cope:
1. My PSA will continue to be measured every three months until I decide otherwise.
2. He will arrange discussions for secondary treatment if my level reaches 0.1 rather than waiting for 0.2.
3. If further treatment is deemed necessary, my case still has many options to consider.
After considering the urologist’s words and a lot of soul-searching, I’ve decided it’s time to make peace with my rising PSA. It’s time I focus on the here and now and stop worrying about what might be. After all, I’m not at the end of options, and new treatments are always on the horizon.
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