The prostate gland produces low levels of a protein called prostate-specific antigen (PSA). Cancerous prostate cells also produce PSA.
Doctors use PSA tests to check levels of PSA in a person's blood. Higher levels of this protein can indicate a problem with prostate health, including prostate cancer.
One treatment option for prostate cancer is a prostatectomy. During a radical prostatectomy, a surgeon will remove the prostate as well as some of the tissue around the gland.
After a prostatectomy, it is normal for a person to continue having regular PSA tests. This helps doctors check that the surgical team removed the cancer successfully, and that it has not returned.
In this article, we discuss why PSA testing is important after a prostatectomy and what the results can mean. We also cover treatment and prevention of rising PSA levels.
Why is PSA testing important after prostatectomy?
A doctor may recommend PSA testing to determine if the prostate cancer has returned after surgery.
It is possible for prostate cancer to return after a prostatectomy. One study from 2013 suggests that prostate cancer recurs in around 20–40 percent of men within 10 years of having a radical prostatectomy.
Although surgeons remove the prostate gland during a prostatectomy, some cancer cells can travel into the surrounding tissue. If these cancer cells multiply, they can cause prostate cancer to return.
PSA testing can help doctors find and treat prostate cancer early. This is why they offer PSA testing, along with other tests, to people after they have treatment for prostate cancer.
What do the results mean?
Doctors measure PSA levels in nanograms per milliliter (ng/mL) of blood. PSA levels change over time and tend to rise with age. They also vary slightly between individuals.
However, according to the Prostate Cancer Foundation, normal levels are within the following ranges:
|Age||Normal PSA range|
|40–49 years||0–2.5 ng/mL|
|50–59 years||0–4 ng/mL|
|60–69 years||0–4.5 ng/mL|
|70–79 years||0–6.5 ng/mL|
The American Cancer Society (ACS) suggest that doctors often recommend that a person waits until 6–8 weeks after surgery before having a PSA test. This is because tests can still detect PSA in the blood after a prostatectomy during this period.
After treatment, people expect their PSA levels to be very low. In many cases, levels of PSA in the blood will be undetectable.
However, if testing does detect PSA after a prostatectomy, this does not mean that cancer has returned. Noncancerous cells can also make PSA. A doctor can advise on whether a person needs further testing or treatment.
Doctors can also advise on what PSA level a person can expect to have after treatment.
Is a rising or high PSA serious?
PSA levels may naturally increase due to age.
Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in PSA levels.
Doctors will usually want to know how quickly levels of PSA in the blood are rising. To find this out, a person will need to have regular PSA tests. If levels of PSA remain stable or rise very slowly, treatment may not be necessary.
In some cases, high PSA levels in the blood are not due to cancer cells. Some factors that can affect PSA levels include:
- older age
A doctor will take these factors and the person's medical history into account when looking at test results. This can help them decide if PSA levels are high enough to cause concern.
Are other tests needed?
A doctor will not generally recommend further treatment after a single PSA test result. They will typically monitor a person's PSA levels over time to see whether they are rising.
PSA testing is only one way to check a person's health after having a prostatectomy. A doctor may use an imaging test to look for a tumor or a growing number of cancer cells.
They are also likely to ask the individual about any possible symptoms that could suggest that prostate cancer has returned.
Treatment of rising PSA
If PSA levels are rising slowly or by a small amount, a person may not need treatment. A doctor usually considers an individual's overall health, medical history, and age when giving advice on treatment.
Doctors often use active surveillance if PSA levels are rising. Active surveillance is a series of regular tests and health checks, with treatment only if necessary. Prostate cancer often progresses very slowly, so it may be many years before a person needs treatment.
If a person has had a prostatectomy, a doctor may also recommend radiation therapy, which kills cancer cells using high-energy particles.
Radiation therapy is not suitable for everyone who has had a prostatectomy. If a person had radiation therapy before surgery, they cannot usually have this treatment again. Having radiation therapy a second time can cause side effects.
Doctors may also use hormone therapy to shrink a person's tumors. This can make other treatments such as radiation therapy more effective.
Prevention of rising PSA
Limiting alcohol intake may help prevent rising PSA levels.
It is not always possible to prevent PSA levels from rising. The best way to safeguard health after having a prostatectomy is by undergoing regular medical checks.
The ACS recommend:
- stopping smoking or using tobacco products
- exercising regularly
- maintaining a healthy weight
- eating a healthful diet, with plenty of fruits and vegetables
- limiting alcohol intake to a moderate amount
Researchers are trying to find ways to improve the PSA test. They hope to be able to tell more accurately whether or not PSA levels point to the presence of cancer cells.
Rising PSA levels after a prostatectomy do not always mean that cancer has returned. It can often take years for cancer to reach a level that needs treatment. Many people will not need treatment at all.
If prostate cancer does return, treatment is often possible. Radiation therapy, hormone therapy, and active surveillance are all options for a person with cancer recurrence after a prostatectomy.
A prostatectomy is one possible treatment for prostate cancer, and it involves surgery to remove the prostate gland.
Follow-up appointments and PSA testing are important to check for signs of recurrence after a prostatectomy. Following this surgery, a person will typically have a PSA test every 6 months.
Doctors are often able to offer a person a care plan to support them after a prostatectomy. This plan may include information and advice on health, diet, screening tests, and expected side effects.