From the Guidelines
Yes, a Prostate-Specific Antigen (PSA) test can be performed after a prostatectomy, and it is a crucial tool for monitoring potential cancer recurrence. After a radical prostatectomy, PSA levels are expected to be undetectable within several weeks of surgery, and any detectable PSA after this period may indicate residual prostate tissue or cancer recurrence 1. The interpretation of PSA levels after prostatectomy differs from men with intact prostates, as even small increases can be meaningful.
Key Considerations:
- PSA levels should fall to undetectable levels (typically less than 0.1 ng/mL) within 4-6 weeks after surgery 1.
- A PSA level of 0.2 ng/mL or higher on two consecutive measurements is often considered biochemical recurrence requiring further evaluation 1.
- Regular PSA monitoring is recommended, with the frequency of testing depending on the time elapsed since surgery and the patient's individual risk factors.
- The American Cancer Society recommends measuring serum PSA level every 6 to 12 months for the first 5 years, then rechecking annually thereafter 1.
Monitoring and Follow-up:
- PSA testing is essential for early detection of possible cancer recurrence, allowing for timely intervention if needed.
- Patients whose PSA fails to fall to undetectable levels or whose detectable PSA increases on two subsequent measurements should undergo a prompt search for the presence of local residual or recurrent disease or distant metastatic disease 1.
- The primary treating specialist should be involved in the follow-up and management of patients with elevated or rising PSA levels 1.
From the Research
PSA Testing After Prostatectomy
- A Prostate-Specific Antigen (PSA) test can be performed after a prostatectomy to monitor for potential recurrence of prostate cancer 2, 3, 4, 5.
- Studies have shown that PSA levels can be detectable after radical prostatectomy, and the use of ultrasensitive PSA assays can detect relapse earlier than conventional assays 3, 4.
- The management of patients with a persistently elevated PSA after radical prostatectomy is often based on salvage radiotherapy with or without hormone therapy 5.
- Research suggests that benign prostatic tissue is unlikely to contribute to measurable PSA levels after radical prostatectomy, and any detectable PSA level is highly suspicious for a malignant origin 6.
- PSA testing after prostatectomy can help identify patients with recurrent disease, allowing for early intervention and treatment 2, 3, 4, 5.
Detection of Recurrence
- Ultrasensitive PSA assays can detect recurrence of prostate cancer with significant lead time over conventional assays 3, 4.
- The use of modern imaging and new treatment options involving the combination of radiotherapy and hormone therapy can contribute to the management of patients with detectable PSA immediately after radical prostatectomy 5.
- A measurable PSA level after radical prostatectomy is an extraordinarily rare event in patients with extremely low-risk disease, and is often associated with a malignant etiology 6.
Monitoring and Treatment
- Patients with a rising PSA level after radical prostatectomy should be monitored closely and considered for salvage radiotherapy with or without hormone therapy 2, 5.
- The treatment options and prognosis for patients with detectable PSA immediately after radical prostatectomy are still unclear, and require further study 5.
- Early detection of recurrent prostate cancer using ultrasensitive PSA assays can provide a significant lead time for treatment, and improve patient outcomes 3, 4.