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POST OP PSA OF 33.5

Hi Doctor,
My husband had a radical prostatectomy in January of 2010.  His first post-op PSA 2.5 months after surgery was 0.34.  His surgeon suggested he repeat PSA in six weeks.  We just received these results and the PSA is now 33.5.  His surgical biopsy revealed a 4+3 Gleason, positive margins, penetration of capsule and invasion of seminal vesicles.  Is it possible that there could be such a rapid rise in PSA levels from 0.34 to 33.5 in six weeks?  Do you think it's possible that this is a mistake?  In all the reading we have done, we have not come across such a drastic rise in post-op PSA.  
Please advise.
Thank you, in advance, for your time.
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A related discussion, STOPPING ADT was started.
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Avatar universal
thanks for your quick response Dr. Tewari.  So it sounds as if you don't think this PSA could have been a mistake.  Would you recommend repeat PSA just to be sure?  I know you've indicated that it is not unheard of to have gone from 0.34 to 33.5 in just six weeks, but i can't seem to find any literature with that kind of drastic rise on a second post-op PSA.
thanks again, for your time.
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242579 tn?1252111171
MEDICAL PROFESSIONAL
Thank you for your question. Extracapsular extension, Gleason 7 (4+3), and SV invasion are all indications of aggressive disease. In addition, positive surgical margins have been associated with local recurrence and distant metastases in cases of men treated for localized prostate cancer. A rapid rise in PSA as described is not unheard of. Imaging studies (MRI and bone scan) should be performed. Adjuvant radiation therapy should be discussed with your physician.

Best of luck

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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