Alright, Dr. Scholz. We know that surgery is an incredibly large topic in the prostate
world, and the most common question is, "What should a man's PSA be after surgery?"
So, PSA levels are supposed to drop to undetectable levels within a month or so after the operation.
People that say have a PSA 10-15 before surgery and then have an operation, it takes a few
weeks for that PSA to get out of the bloodstream. So, doctors will recommend waiting a month
or two, but the PSA should be basically undetectable. The exception to the rule, of course, if there's
any cancer left behind and the other exception to the rule is if the prostate gland it not
entirely removed and this happens. Doctors have the best intentions to get the whole
prostate out, but they don't quite get it all and so some men are walking around who've
been cured of prostate cancer. Their cancer was removed, but a small sliver of prostate
was left behind the PSA may be hovering around 0.1 or something like that. The surgeons like
to use the threshold of 0.2 as concrete evidence for a cancer relapse acknowledging that sometimes
a little bit of gland is left behind. But with good surgeons, it's pretty uncommon to
have detectable PSA. So if the PSA is detectable at all, it should be a less than sign in front
of the number <0.02. Some of the labs have different thresholds of what is undetectable,
but if the PSA is not undetectable a month or two after. surgery, then that,of course,
is a major concern.
So, should a man be getting his PSA tested every month after surgery?
Probably every three months. A similar program to what we use in men that are being monitored
for radiation therapy. They'll get PSAs every three months for a couple of years. Every
six months for 2-3 years, and then you hit the five-year milestone and then you go to
once a year.
Now, going back to when a surgeon possibly leaves part of the prostate. How do they detect
that? Like, how do they know? Do they go to imaging and they're like, "Oh, part of the
prostate was left..." Or how would that be found?
You could do imaging. The PSA rate of change over time is probably the best way to differentiate
some cancer that's growing, the PSA will continue to rise with a doubling time of anywhere from,
you know, 1-15 months, something of that nature, whereas if it's just a little chunk of prostate
gland, it's just going to stay the same number because prostate gland doesn't multiply and
replicate. So watching it over time and if the PSA remained nice and stable, that's a
pretty clear indication that a piece of prostate gland was left behind.
So, if a man's PSA is rising after surgery within what time frame should he be taking
action and talking to his urologist? Because I've talked to a lot of patients where the
urologist is like 6 months out—well let's wait, and the PSA is rising. So what time
frame should it be?
Well, there's really no reason to wait once you're convinced that it rising because after
surgery—unlike radiation, you know, it could be a bump—but after surgery it's cancer.
That's the only thing that causes a rising PSA after surgery. So, you want to start looking
for the cancer. The treatments to try and cure it are, you know, like radiation, hormone
therapy, these sorts of things. Combinations of radiation plus hormone therapy and so you
really want to get after it as soon as you can. The studies clearly show that if you
allow the PSA to rise higher and higher, the chances for being able to cure it start to
go down.
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