From the Guidelines
Yes, a PSA increase from 0.1 to 4.2 one year post-prostate cancer surgery is a significant concern and indicates biochemical recurrence of prostate cancer, requiring immediate medical attention. This pattern suggests that cancer cells may be growing somewhere in the body, as PSA levels should remain very low (typically <0.1 ng/mL) after radical prostatectomy since the prostate gland has been removed 1. According to the American Society of Clinical Oncology, patients should be informed that the development of a PSA recurrence after surgery is associated with a higher risk of development of metastatic prostate cancer or death resulting from the disease 1.
Key Considerations
- The definition of biochemical recurrence is a detectable or increasing PSA value after surgery that is ≥ 0.2 ng/mL, with a second confirmatory level ≥ 0.2 ng/mL 1.
- A restaging evaluation in a patient with PSA recurrence may be considered to locate where the cancer might have returned 1.
- Treatment options will depend on where the recurrence is found and may include radiation therapy, hormone therapy (such as leuprolide, bicalutamide, or enzalutamide), or other systemic treatments 1.
- The speed of PSA rise (doubling time) and the timing after surgery are important factors that your doctor will consider when determining the appropriate treatment approach.
Next Steps
- Contact your urologist or oncologist immediately to discuss these findings and develop a management plan.
- Imaging studies such as bone scans, CT scans, or newer techniques like PSMA PET scans may be necessary to locate where the cancer might have returned.
- Physicians should offer salvage radiotherapy to patients with PSA or local recurrence after radical prostatectomy, in whom there is no evidence of distant metastatic disease 1.
From the Research
PSA Increase After Prostate Cancer Surgery
- A PSA increase after prostate cancer surgery can occur, and it is essential to monitor PSA levels regularly to detect any potential recurrence or progression of the disease 2, 3.
- In the given scenario, the PSA level increased from 0.1 to 4.2 around 1 year post-surgery, which may indicate biochemical recurrence 2.
- Biochemical recurrence is defined as a rise in PSA level after radical prostatectomy, and it can occur even with undetectable PSA levels initially 2, 4.
Factors Influencing PSA Increase
- The risk of PSA increase is influenced by various factors, including the baseline PSA level, Gleason score, and surgical margins 2, 3.
- A study found that the cumulative rate of freedom from PSA increase above 4.0 ng/ml was significantly decreased with higher baseline PSA ranges, regardless of age range 5.
- Another study suggested that androgen deprivation therapy (ADT) can increase PSMA expression, which may improve the performance of PSMA-PET imaging in primary staging of prostate cancer 6.
Management of PSA Increase
- The management of PSA increase after prostate cancer surgery depends on various factors, including the extent of the increase, the presence of symptoms, and the patient's overall health status 2, 3.
- Salvage radiation therapy (SRT) and ADT are potential treatment options for patients with biochemical recurrence after prostatectomy 2.
- The decision to use ADT should be based on individual patient factors, including the PSA level before SRT, Gleason score, and surgical margins 2.