UTI and PSA level after prostatectomy

Dear All,

My father was diagnosed with prostate cancer 1y ago. He got laparoscopic radical prostatcetomy:
- preoperrative PSA 4.6
- Gleason post-operrative 4+3, T3a N0, with polineuralinvasion. All marginesu were negative.
Post operrative PSA:
3m < 0.006
6m = 0.008
12 = increases to 0.209. He re-checked the results after 4 and 12 days, and it shows 0.25 and 0.28 accordingly. So 0.07 increase within 12 days.

During the time he did the test he was during penil rehab after prostatectomy which was quite strong with exercises on the Ball, massages etc. Unfortunatelly it comes out the he has also urinary infection with big amount of bakteria in urine ~10^6.

Do you have any experience with UTI after prostetectomy? Isbit possible that UTI can falsely rise PSA level without biochemical recurrences. What worries me is also the fact his testosterone level is quite high: 27nmol/l with the norm to 25.7nmol/l.

Is it possible that still PSA level is not related to cancer. I feeling a Little bit nervous because in the country I am living waiting for medical appointment take a little time. Currently he has got scheduled MRI of prostate, Tomocomputer of check and abdominal cavity, and scyntygrphy. The doctor said that if they find something he will be scheduled for radiotherapy. All of mentioned tests are planned within 2m and I worry it is too long having so fast PSA increase.

Thanks in advance for your comments

Anything is possible but my first guess would be that a UTI after prostatectomy would not generate PSA at the 0.21+ levels observed. He probably should re-check PSA after being on UTI antibiotics for the prescribed time period and see if there is any difference other than upwards.

The scans mentioned may or may not show anything with PSA at low levels. The hope is that they don't find anything but if they find something, it is hopefully something in the local area that can be targeted along with salvage radiation of removed prostate area. Regardless of scans, if his PSA keeps rising then radiation to former prostate area is a standard procedure. In the US, a PSA >0.20 after surgery almost always triggers radiation treatment along with hormone therapy.

There is PSMA PET/CT scan that has been approved in the US and elsewhere that can seek out prostate cancer better and show in imaging that other scans cannot do at low PSA levels. You may wish to inquire if that is available in your country.

2 months to complete scans is a long time. If his PSA continues to rise weekly, early treatment should begin within 2 months or get the scans done faster. An oncologist should be part of his team at this point if his PSA keeps rising. Just my morning thoughts....

Thank you for your feedback.

Yes, dad is on UTI antibiotic, but he started to take them yesterday.

In Poland we do not have decipher test, I have read about it. We got something similar but is very expensive.

PET PSMA is avaialble but have heard it is reliable only when PSA reach >0.5.

I worry about so quick PSA rise, and hoped it could be related to UTI.

Regarding his post-operative histopathology, in fact there was focal growth of the cancer through the prostate capsule but all margins were negative.

Post Edited (Jane_jane) : 5/24/2023 9:59:48 AM (GMT-8)

This may or may not help a little with the issue of PSA vs. PSMA scan.

Rahul Tendulkar, MD: Yeah, that's a great question. So historically in men with a rising PSA, the effectiveness of radiation therapy depends on the PSA level at which we're treating somebody. So for example, if somebody has a relatively low PSA, like 0.2 or in that ballpark, they might have an expected success rate with salvage radiation in the order of maybe 70, 75%, something like that. For those who have a PSA, more like 0.5 or higher that success rate drops pretty quickly, maybe 50, 60% or something like that, depending on their pathology findings.

And so that's a large percentage of people that were treating, who then subsequently recur and may have had potentially unnecessary treatment that would subject them to side effects from that. And so this has been, I think, really helpful to try to select patients a little bit better. And I think that's been, in your world of oncology as well, I think we're seeing a lot of the recent trends and things that we're trying to achieve is really selecting the right treatment for the right patient at the right time and trying to balance aggressiveness of our treatments to the aggressiveness of how the disease is behaving and then trying to back off when we don't need to. And so I think this has been a really helpful approach.

https://my.clevelandclinic.org/podcasts/cancer-advances/psma-pet-scan-improving-treatment-for-patients-with-prostate-cancer

Yes, we will for sure do MRI (next Monday) and I am trying to encourage dad to do PET PSMA instead of scintigraphy. He wants first to check the PSA trend after 1 week of antibiotics and then decide. So I need to respect his decision.

He should see a radiation oncologist (RO) for a treatment opinion. Early radiation can provide better results if cancer is in local area. The article I quoted above should give him support for considering RT now.