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psa after prostate removed?
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jump62 posted:
I see people on here talk about psa reading after prostate was removed. If the prostate was totaly remove how can you ever get a psa reading that is connected to the prostate? Or is it that some of the prostate is still left behind even though they say it was removed? I also have read that you can get psa reading that are caused by other parts of the body is this correct?


Thanks jump62
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Galileo1962 responded:
Jump, it depends on how closely it is measured. In my case, I have the standard assay which goes to 0.1, so all the lab can say is that mine is less than 0.1. And that translates to one tenth of one billionth of a nanogram per milliliter of blood. Incredibly small!

Ultrasensitive tests take this much further, so far down that (in my layperson's view) you sometimes see "noise" in the results--meaningless small movements. Ultrasensitive tests are, I think, also picking up PSA produced outside the prostate, so it's important to look for a pattern of sequential rises. Google "extraprostatic sources PSA" and you'll see plenty of literature on this. If a bit of benign tissue was left behind, that could also produce some PSA.

"(PSA) anxiety relates to the fact that extraprostatic sources of
PSA production are known to exist (Kamoshida and Tsutsumi,
1990; Yu et al, 1995). Nevertheless, this is a very small contribution to serum PSA (Oesterling et al, 1996) and is believed not to complicate the interpretation of monitoring since these sources contribute a stable amount of PSA in the serum, which does not change with time."
"Undetectable ultrasensitive PSA after radical
prostatectomy for prostate cancer predicts relapse-free
survival"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2363433/pdf/83-6691474a.pdf

PSA is even present in small amounts in breast milk and amniotic fluid. http://www.clinchem.org/cgi/content/abstract/41/1/54

So there are reasons for PSA to be present at very small levels even after prostatectomy. What matters is the trend over time.
That said, after successful prostatectomy a man should see his PSA fall to less than 0.1 and stay there (per Walsh) although there is a small subset of men who will subsequently see their PSA rise back to a just over that mark and stay there (thus the reluctance to start salvage radiation until a clear pattern is seen).

All of this is, of course my layman's meandering Sunday morning thoughts, and I'd love to hear what Dr. Moul and John (az4peaks) have to say.
 
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Judd W Moul, MD responded:
If the prostate gland is completely removed, the PSA should go to undectable-which for most labs is less than 0.1ng/ml. If the PSA goes above 0.2ng/ml after radical prostatectomy and stays above 0.2ng/ml on a repeat test, it is the definition of recurrence. However, sometimes with a nerve-sparing radical prostatectomy, some of the "shell" of the prostate may be left in the body and this can produce a little PSA-generally in the range where the PSA will be from 0.1 to 0.3ng/ml. The PSA is only produced by the prostate gland, but if any prostate cancer cells remain after surgery, they will eventually start to produce PSA. Only the prostate gland cells have the "cellular machinery" to produce the PSA chemical in the body. After surgery, if the PSA goes above 0.4 to 0.5ng/ml, most experts then are pretty sure this is from cancer and not just from non-cancerous prostate "shell".
 
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An_216455 replied to Judd W Moul, MD's response:
My father having Prostate cancer .already removed his testis.is it removed prostate gland also.presently
he facing 01)abnormal sciatica pain
02)increasing of PSA level (present his PSA goes to 40ng/ml.)
03)constipation problem.
Presently he takes TABI tablet daily one.
my oncologist still not recommended for radiation and chemotherapy,she refer only neurophysion.
Please guide me immediatly
 
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hackwilson replied to Judd W Moul, MD's response:
I had a robotic prostectomy July 5, 2011. psa on 10-11 was <0.1; psa on 1-12 was <0.1; psa on 4-12 was 0.1; psa on 4-13 was 0.2; psa on 7-13 was 0.19. Should I continue to test my psa or start radiation therapy?
 
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meidoorn replied to hackwilson's response:
If you're still with us, just test every .5 yr, if it stays stable for a few years test once a year


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