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Prostate Cancer

PSA Post Surgery - Tissue Left Behind

02/28/2010

Question:

Upon my first follow-up visit 4 months after my robotic RP in Sept. 2009, a PSA level of .19 was detected. Prior to surgery, one of 8 biopsy "samples" contained disease and only to a degree of 6%. My pre-surgery PSA was 4.6, with a Gleason score of 3+3. I am 59 yrs old and had bladder surgery twice, at ages 8 and 10, to correct a congenital stricture in my right ureter. My surgeon thinks there`s a possibility that prostate tissue was left behind amid the significant amount of scar tissue from the bladder surgeries. Is that possible?

Answer:

It is possible that a PSA of 0.19 could be due to prostate tissue being left behind, which could be either non cancerous tissue (less common) or cancer cells. You have not provided details about the final pathology report after surgery, though your initial biopsy did seem to favor a low grade, low volume disease.

If the final pathology also showed a similar low grade disease with negative surgical margins, then the likelihood of microscopic cancer being left behind would be very low. However, it would be important to monitor the PSA carefully to see whether it increases over time, the next PSA could be done after 3 months. If the PSA continues to increase then that would be more concerning for residual cancer cells and would need to be addressed accordingly.

I have attempted to interpret your situation based on the limited information available, but it is important to look at these PSA levels in the context of your particular clinical situation and the final stage/grade of your cancer, which your urologist would be able to do.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati