PSA GOES UP AFTER SURGERY?

You will be given general anesthesia, which means you’ll be unconscious during the procedure. To reach the prostate, surgeons make an incision just above the rectum. The prostate is gradually separated from the rectum, bladder, urethra and vas deferens. The seminal vesicles are removed along with the prostate, and then the bladder is linked once again with the urethra.

If a man’s PSA level goes up after a radical prostatectomy, this is an indication that there is prostate cancer somewhere. Maybe it’s a local recurrence, in the area where the prostate used to be, or perhaps it’s a distant metastasis—a tiny seed of cancer that got scattered long before the cancer was ever diagnosed.

How to tell which? Recently, Johns Hopkins investigators studied rising PSA levels in fifty-one men after radical prostatectomy. In 30 percent of these men, cancer returned locally; in 70 percent, the cancer showed up as distant metastases. Based on this study, the scientists found they can estimate which course the cancer will take using the Gleason score of the prostate specimen removed in surgery, the pathologic stage (which is based on study of the actual prostate—not just tissue samples, as in biopsy), and timing—when the PSA starts to rise.

Men most prone to distant metastases will have one or more of these conditions: Gleason scores of 8 or higher, cancer found in their seminal vesicles and lymph nodes during surgery, or a rise in PSA within a year after their surgery. Conversely, men with Gleason scores of 7 or lower, low pathologic stage, and/or increases in PSA several years after surgery most likely will have only a local recurrence of cancer. For these men, the good news is that this cancer may still be cured with external-beam radiation treatment to the prostate bed (the area where the prostate used to be.

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