In August I underwent a radical prostatectomy and pathology indicated that the cancer had not spread outside of the prostrate. My first PSA test results, about 45 days after surgery, was 0.03. 90 days later I had my second PSA test, which came back 0.05. Is a fluctuation of this nature to be expected in successful cases? Given the post surgical pathology report and the fact that I no longer have a prostrate gland producing PSA, shouldn't the PSA reading be 0.00?
On PSA dropping to 0.00 and PSA sources other than prostate :
You are correct in assuming that the ideal outcome is to have an undetectable PSA level after prostatectomy. With the development of more sensitive tests for PSA, it is possible that there may be leakage of PSA from other fluids (such as fluid in the spine, the lining of the internal abdominal and thoracic organs). In general, if the level is consistently below 0.05, there should be no need for concern.
On whether your reports suggest normal fluctuation:
In your case, we need to consider if this increase represents something to be worried about (whether or not recurrence is probable). It's too early to say as the interval of observation is very short. It is possible to estimate how fast the PSA doubles as an indicator to tell if it really represents a recurrence. The longer the follow-up the more accurate the test becomes, although I understand that patients tend to be anxious during this period of observation. Best estimates are with 18 months and 3 determinations, about one every 6 months, to get a feel of the speed that PSA rises. 18 months is a pretty long time even though you are not feeling anything. Perhaps initial results at the 6 month interval would be a start in deciding what to do next. Its best you also review all the previous findings, tests before the operation, findings during operation and pathology reports to estimate when intervention would be needed, and which intervention is appropriate.
At some point, you may need to make a value judgment based on your personality. Some patients do start a treatment acceptable to them earlier than the recommended testing follow-up. Discuss all concerns at length with your doctor before making a decision.
My best to you.
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