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Posted 2/7/2017 8:51 PM (GMT 0)
Hi Folks,

I have a question: After a prostatectomy, my understanding is that one should no longer be able to detect any PSA level, correct? If not, how is it possible to have a change in PSA if you no longer have a prostate? I understand that one may still contract different cancers in the same general area.

Thank you!
Posted 2/7/2017 9:01 PM (GMT 0)
That's pretty much correct. With only the small exception of some residual tissue left behind which could produce a small amount of PSA, after RP (radical prostatectomy) there should essentially be no remaining PSA in your bloodstream...unless there is also residual prostate cancer.

If the PC spread from one's prostate prior to removal, it will produce PSA which will get picked up in the bloodstream. So, the purpose of having a series of PSA tests after RP is to check whether there was residual PC, which would be indicated by a generally small but growing level of PSA over time. Residual PC will likely be treated with a 2nd-line of treatment.

PC is the only cancer that generates PSA.
Posted 2/7/2017 9:09 PM (GMT 0)
Thank you for the clarification, Jack.
Posted 2/7/2017 10:03 PM (GMT 0)
Trivia complementary info:

Wikipedia said...
PSA in other biologic fluids and tissues

It is now clear that the term prostate-specific antigen is a misnomer: it is an antigen but is not specific to the prostate. Although present in large amounts in prostatic tissue and semen, it has been detected in other body fluids and tissues.

In women, PSA is found in female ejaculate at concentrations roughly equal to that found in male semen. Other than semen and female ejaculate, the greatest concentrations of PSA in biological fluids are detected in breast milk and amniotic fluid. Low concentrations of PSA have been identified in the urethral glands, endometrium, normal breast tissue and salivary gland tissue. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer.

Posted 2/7/2017 10:21 PM (GMT 0)
If your surgery was successful, your PSA will be undetectable on an ordinary PSA test by 3 months after surgery. Benign prostate tissue that may have been left behind will stop producing PSA by then too. Ordinary PSA tests detect PSA down to 0.1 ng/ml.

Ultrasensitive PSA tests may detect PSA as low as 0.01 ng/ml (there are super-ultrasensitive PSA tests that go as low as 0.003 ng/ml - but at that point, unimportant non-prostatic sources may become detectable). After a prostatectomy, I think it's important to use an ultra-sensitive PSA test to monitor for recurrence.
Posted 2/7/2017 10:25 PM (GMT 0)
Thank you Allen.

Who do I speak to about getting an "ultra-sensitive" PSA test? Should my lab be able to perform one?
I'll ask my surgeon as well.

Thank you for the information.
Posted 2/7/2017 10:30 PM (GMT 0)
You had a low-risk case at diagnosis, and a favorable pathology...you don't need the ultrasensitive PSA. It gets over-used on such cases. It is useful for men who might actually have some meaningful risk of recurrence.
Posted 2/7/2017 10:31 PM (GMT 0)
Tell your urologist you want it (I would insist). Many labs offer it or can send it out to one that does. You can google "ultrasensitive PSA laboratory Kansas City" to find one that does.
Posted 2/7/2017 10:45 PM (GMT 0)
Thanks Allen.

Will do.
Posted 2/7/2017 10:59 PM (GMT 0)
Allen,

Do you still recommend I do the ultra sensitive PSA test?

The lab just came back and told me that the lab reports you exact PSA was 0.008.

Thx
Posted 2/7/2017 11:46 PM (GMT 0)
That is an ultrasensitive test result. Congratulations - great number!
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