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Tuesday, December 10, 2013
Increase in PSA With Prostate Removed
My friend had prostate surgery a year and a half ago. Had the prostate removed and was told that they got it all. Since then, his numbers have risen steadily. Right now it is 1.1. The doctor is recommending a cat scan and bone scan. My question is: if the prostate is what produces the PSA, now that the prostate is removed, where are the numbers coming from?
PSA is useful but does not provide a diagnosis. While we generally accept three common causes of increased PSA (benign prostate hyperplasia or BPH, prostatitis, and prostate cancer) the process of evaluating each individual requires the combined assessment of risk factors which include PSA, physical exam (digital rectal exam or DRE), family history (increased risk of prostate cancer in men with first degree relative having prostate cancer- especially father or brother), and race (African American male at greater risk than others).
I have recently seen a patient who had undergone 8 biopsies over 10 years prompted by rising PSA from 8 ng/ml to 32 ng/ml. After 8 biopsies which were all benign, the ninth biopsy proved to be prostate cancer. So, to answer your question regarding "how many biopsies are enough?" we do not know and we are compelled to repeat biopsies as long as the information provided by PSA and DRE indicate that the risk of prostate cancer is significant. Not knowing all relevant risk factors but only your age and progressive increase in PSA, I would recommend that prostate biopsies continue unless another explanation for increased PSA is provided by physical exam or biopsy pathology. I hope this advice is helpful.
James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati