I had a PSA of 9.6 found during an annual physical. I opted for a robotic prostatectomy. One month afterward the PSA did not go down. I had a bone scan, a CT scan anjd a prostascint and all were clear. The path report after the surgery showed that the margins and lymph nodes were clear,but the PSA remained9.6 - 10. On May 5 I was started on Hormone Therapy (trelstar) and I took casodex for the first two weeks as well. Almost immediately (June 9) the PSA came back undetectable. My question is: Is it possible the PSA was taken too soon, and would have dropped to undetectable without the Hormone therapy?
Thank you for your question. The PSA should at least have shown some downward trend at 4 weeks after surgery. Metastatic focus is quite likely although may not have been picked up by investigations. Another way to confirm is to stop the hormone for few weeks and then see how the PSA behaves. If there is a metastatic focus, PSA will start rising again.
Ashutosh (Ash) K. Tewari, MD
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