rising psa after radical prostatectomy

Kongo said:

Not sure I understand
Worried Wife:

I'm about confused about what your doctor relayed to you when he explained potential rises in your husband's PSA reading. I certainly agree with his discussion about prostate tissue left behind after an RP. That is always the case after surgery. What I do not understand is his discussion about another gland being "out of whack." I don't know what that means unless he is suggesting that prostate cancer has spread to another place, such as a lymph node or seminal vesicle, liver, lung, or bone but technically those aren't "glands." PSA comes from prostate cells. When a man has a prostate, non cancerous PSA elevations can be caused by a urinary tract infection, BPH, a biopsy, or other inflammation. Short term PSA elevations can come from ejaculation, a DRE examination, a hard stool, or even bicycle riding. Since your husband had his prostate removed more than 10 years ago, there really isn't another potential cause of the PSA elevation except for a return of prostate cancer where these cells (regardless of where they now are in the body) are generating PSA. The only possibility I can imagine that could be an alternate explanation is an error in the PSA reading due to equipment calibration, human error, or some accidental contamination of the blood sample. I would be fascinated to know what other glands he is talking about when he suggested to you that "... other glands could cause the sudden rise..."

I am certainly not trying to scare you or give you gloomy news but I think you and your husband deserve accurate and precise information about what is happening and why and what options you have to deal with it. Doctors should take pains to explain to you what is going on in exact terminology and make sure you understand it. Terms like "out of whack" only make sense if you understand the chemistry and biology of what is going on at the microscopic level. I do hope that your next reading comes back at the very low levels you have experienced for so long but you should also be prepared for what you should do if it comes back and shows another increase.

I was also surprised to see than in antother post on this thread that you indicated that your urologist doesn't believe in hormone therapy and would probably do radiation instead. Radiation is a common treatment for recurring prostate cancer but so is hormone therapy or a combination of both hormone therapy and radiation. Most studies show that there is a much higher long term prognosis with a combination of hormone therapy and radiation than with either treatment used alone.

As with any diagnosis of this serious nature, I would seek a second opinion on your doctor's recommendations.

Best of luck to both of you.

Not sure I understand
I agree that if things are not explained properly, I will seek another opinion. I replied above to correct myself in that my husbands PSA was at 0.002 not0.02 in April and then jumped to 3.7 6 months later.

I was not happy with his explanation and he seemed surprised that I met with him after he spoke with my husband and told him he would retest in 3 months. My husband had a brain injury last year and is almost back to his normal self with some residual minor issues. He had a great neuro surgeon. But, due to this issue, I have to get first hand information to understand what is going on. I also was not happy that he seemed so aloof about it all.

I am thinking of calling his original surgeon if it turns out it is cancer again. This urologist talked to us like it was no big deal. He said since it is 10 years out he doubts recurrence, rather it would be more likely a new cancer????? Yes, that made me feel good. Then as we were leaving he said if it is recurrence, they would just shoot radiation into that area and it would be all better. Then he said he was not a fan of hormone therapy.

Thank you for all your words of wisdom.

worriedwife said:

Not sure I understand
I agree that if things are not explained properly, I will seek another opinion. I replied above to correct myself in that my husbands PSA was at 0.002 not0.02 in April and then jumped to 3.7 6 months later.

I was not happy with his explanation and he seemed surprised that I met with him after he spoke with my husband and told him he would retest in 3 months. My husband had a brain injury last year and is almost back to his normal self with some residual minor issues. He had a great neuro surgeon. But, due to this issue, I have to get first hand information to understand what is going on. I also was not happy that he seemed so aloof about it all.

I am thinking of calling his original surgeon if it turns out it is cancer again. This urologist talked to us like it was no big deal. He said since it is 10 years out he doubts recurrence, rather it would be more likely a new cancer????? Yes, that made me feel good. Then as we were leaving he said if it is recurrence, they would just shoot radiation into that area and it would be all better. Then he said he was not a fan of hormone therapy.

Thank you for all your words of wisdom.

Worried Wife
I understand the frustration you have with your urologist and in my opinion he should have taken more time to explain his thoughts. I also understand your anxiety from dealing with these new issues as your husband recovers from his brain surgery.

In your original post you mentioned that your husband’s original PSA was 1.4 and that some prostate cancer was discovered during a TURP procedure. I am assuming that the TURP was performed to alleviate some urinary discomfort from an enlarged prostate. Prostate cancer frequently begins to show itself at the same time as BPH (benign prostate hyperplasia). As you may know, very often incidental prostate cancer is found in men beyond the age of 50 without any other indications. Frequently this incidental cancer is indolent, very slow growing, and never poses a threat to the patient. Without knowing the details of the post RP biopsy this is just speculation but it’s certainly possible that the PSA you are seeing now is a result of a small amount of cancer left behind from the original surgery that has taken ten years to reach a stage where it is making enough PSA to show up. Remember that most forms of prostate cancer are very, very slow growing and these cancer cells only divide about every year and a half.

Prostate cancer spreads through the blood stream and the lymphatic system so it is possible that in the years since the original RP that prostate cancer has taken hold in a nearby lymph node or seminal vesicle (you will want to check the records from the prior surgery to see if they were removed or not). Outside the prostate, cancer grows faster than it does inside the prostate and PSA will tend to increase more quickly. Some scientists believe that the prostate produces protective tissue that acts to isolate the cancer but that outside the prostate this does not happen.

Given that your husband’s prostate was removed, it is difficult to imagine that this is a new prostate cancer distinct from the earlier form. Although since there was undoubtedly some prostate tissue left behind after his RP, I suppose it is possible but I have never heard of that happening. Most likely, it is a continuation of the previous cancer and recurrences after ten years or more while uncommon are not unheard of.

It’s entirely possible that if you do discover that prostate cancer has returned that it is a very slow growing, indolent type of cancer that does not pose a health threat. I would be prepared to calculate the PSA velocity which is a valuable tool in determining the severity of any recurring cancer. I also urge you to seek out second opinions, particularly if you’re second guessing whether or not your existing medical team is meeting your needs.

2ndBase said:

Another gland
When I was first diagnosed 7 years ago this week I was told by my urologist that another gland also puts out small amounts of a tertosterone type chemical that makes the cancer grow faster. It may have been the throid but its been a long time and my memory is not that good. Anyway, he put me on some pill to discourage this from happening. I too am not a fan of hormone therapy and speak from experience. Side effects are not worth the time in my opinion.

another gland
Thank you for letting me know and I think in my stressful visit, he might have mentioned
the thyroid gland.

What kind of side effects have you had with the radiation and/or hormone therapy?

I am so glad there are people here to talk to and vent. I truly appreciate any and all input.