PSA, Post Prostatectomy

The PSA, Post Prostatectomy test contains 1 test with 1 biomarker.

Brief Description: The PSA Post Prostatectomy test is a critical diagnostic tool that plays a significant role in monitoring the health of individuals who have undergone prostatectomy, a surgical procedure to remove the prostate gland. This specialized test helps healthcare providers assess the effectiveness of the surgery, monitor for recurrence of prostate cancer, and make informed decisions regarding further treatment strategies. In this comprehensive guide, we will delve into the details of the PSA Post Prostatectomy test, its indications, significance, and how healthcare professionals interpret its results.

Also Known As: Prostate Specific Antigen Test, PSA Test, Prostate test, PSA Total Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Post Prostatectomy PSA test ordered?

PSA is commonly ordered as a routine test in men over the age of 55, or 40 if they have a relative who has had prostate cancer. It is used to help identify, diagnose, and monitor prostate cancer. This test should also be ordered if the patient is having difficulty urinating or it becomes painful to do so.

The guideline is to start testing at age 40 or 45 for people at high risk, such as African-American men and men with a family history of the condition.

A healthcare professional may schedule a repeat test a few weeks later if the total PSA level is elevated to see if the PSA concentrations have returned to normal.

When a man's total PSA is significantly elevated, a free PSA is usually ordered. The results provide further information to the healthcare professional regarding whether the person is at an elevated risk of prostate cancer and aid in the choice to biopsy the prostate.

The total PSA may be conducted at regular intervals during the treatment of men who have been diagnosed with prostate cancer, as well as when a man is on "watchful waiting" and not currently being treated for his cancer.

What does a PSA Blood test check for?

PSA is a protein produced predominantly by cells in the prostate, a tiny gland that surrounds the urethra in males and generates a fluid that is a component of semen. The majority of PSA produced by the prostate is discharged into this fluid, but minor amounts can also be found in the bloodstream. This test determines how much PSA is present in the blood.

The PSA test is used to screen for and monitor prostate cancer as a tumor marker. It's a good tool, but it's not perfect, and most experts agree that asymptomatic men should only be screened after having a detailed discussion with their healthcare professionals about the benefits and dangers, and after making an informed decision to do so. PSA levels that are high are linked to prostate cancer, but they can also indicate prostatitis or benign prostatic hyperplasia. PSA levels rise with age in all men, but men of African American ancestry may have greater levels than other men, even at a younger age.

PSA is not a cancer indicator. The prostate biopsy, which involves taking small samples of prostate tissue and examining them under a microscope for abnormal cells, is the gold standard for detecting prostate cancer. The total PSA test and the digital rectal exam are used to evaluate whether a prostate biopsy is necessary.

The purpose of prostate cancer screening is to discover the disease when it is still contained within the prostate. Once the diagnosis of prostate cancer has been verified by biopsy, a treatment decision must be determined. As men get older, prostate cancer becomes more common, and many, if not all, of the tumors are slow-growing. While prostate cancer is the second leading cause of mortality in men, slow-growing prostate cancer is a rare cause of death. A pathologist may be able to tell the difference between cancers that grow slowly and spread to other regions of the body and cancers that grow quickly and spread to other parts of the body.

Overdiagnosis and overtreatment are two challenges that health professionals are currently dealing with. In certain situations, the treatment is worse than the cancer, with substantial side effects including as incontinence and erectile dysfunction possible. In general, neither the PSA test nor the DRE can indicate how a person's condition will progress.

In the blood, PSA is found in two forms: complexed and free. The total PSA test, which analyzes the sum of complexed and free PSA in the blood, is the most often used PSA test.

When the total PSA is only slightly raised, the free PSA test is occasionally used to help assess whether a biopsy should be performed. PSA is an enzyme, and when it is released into the bloodstream, some circulating proteins link to it and inactivate it. In BPH, benign prostate cells produce PSA that is not active, whereas malignant prostate cells produce PSA that is already protein-bound.

As a result, men with BPH tend to have greater levels of free PSA, while men with prostate cancer have lower levels. Even if total PSA is not dramatically raised, a relatively low amount of free PSA raises the chances of cancer.

Lab Tests often ordered with a PSA Post Prostatectomy test:

When a Post-Prostatectomy PSA test is ordered, it's often part of a broader evaluation of prostate cancer management. Here are some tests and assessments commonly ordered alongside it:

1. Testosterone Level:

   • Purpose: To measure the level of testosterone in the blood.
   • Why Is It Ordered: To evaluate the effect of hormone therapy, if used, as testosterone can stimulate prostate cancer growth.

2. Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP):

   • Purpose: To provide a broad overview of the body's overall health.
   • Why Is It Ordered: To monitor general health status, especially if the patient is receiving additional treatments like chemotherapy or hormone therapy.

3. Alkaline Phosphatase:

   • Purpose: To measure the level of alkaline phosphatase, an enzyme found in the bone and liver.
   • Why Is It Ordered: To assess for bone involvement if there is a suspicion of metastasis, as alkaline phosphatase can be elevated in bone metastasis.

4. Hemoglobin and Hematocrit:

   • Purpose: To measure red blood cell levels.
   • Why Is It Ordered: To assess for anemia, which can occur with advanced cancer or as a side effect of some cancer treatments.

These tests and assessments, when ordered alongside a Post-Prostatectomy PSA test, provide a comprehensive evaluation of prostate cancer management post-surgery. They are crucial for detecting residual or recurrent disease, assessing the effectiveness of treatment, and managing any complications or side effects. The specific combination of tests will depend on the individual’s treatment history, current health status, and clinical presentation.

Conditions where a PSA Post Prostatectomy test is recommended:

The PSA Post Prostatectomy test is specifically ordered for individuals who have undergone prostatectomy surgery, particularly those with a history of prostate cancer. It is essential to monitor PSA levels to detect any signs of residual cancer cells or recurrence.

How does my health care provider use a PSA test?

Both the PSA test and the digital rectal exam can be used to screen for prostate cancer in both asymptomatic and symptomatic men. PSA is a protein produced predominantly by prostate cells. The majority of PSA is released into the sperm, although minor amounts are also released into the blood. PSA is found in the blood in two forms: free and complexed. PSA levels can be measured in the lab as either free or total PSA.

Some organizations, such as the United States Preventive Services Task Force, believe that the risks of over-diagnosis and over-treatment outweigh the potential advantages of PSA screening in healthy men of any age, and advise against using PSA to test for prostate cancer in healthy men of any age. Before deciding whether or not to be screened for prostate cancer, the American Cancer Society and the American Urological Association urge that men consider the benefits and drawbacks of PSA-based screening with their healthcare professional.

While elevated PSA levels are linked to cancer, they can also be produced by disorders like benign prostatic hyperplasia and prostate inflammation. A biopsy may be required in the case of an increased PSA, which carries the risk of consequences such as discomfort, fever, blood in the urine, and urinary tract infection.

Even though prostate cancer is the second most frequent cancer in males and the second leading cause of death, many prostate tumors grow slowly. These slow-growing kinds may never create symptoms or pose a threat to one's life. Prostate cancer discovered by screening, on the other hand, may be treated with surgery or radiation therapy, which can have major side effects like incontinence or erectile dysfunction.

Because the total PSA test might be temporarily raised for a variety of causes, if an initial PSA is elevated, a follow-up PSA may be performed a few weeks later to see if the PSA is still elevated. If the repeat test shows an elevated level, a healthcare professional may suggest taking a series of PSAs over time to see if the level drops, stays elevated, or rises. When a cancer looks to be slow-growing, the healthcare professional and patient may decide to watch its progress rather than treat it right away.

A free PSA test can be done to look at the ratio of free to total PSA if the DRE is normal but the PSA is considerably increased. This can assist distinguish between prostate cancer and other sources of increased PSA that aren't cancer.

If either the PSA or the DRE are abnormal, other testing may be ordered. A urinalysis, for example, can be used to screen for a urinary tract infection, and imaging tests like an ultrasound can be used to inspect the prostate.

The total PSA test may be used as a monitoring tool to help determine the success of treatment if prostate cancer is diagnosed. It may also be ordered following therapy at regular intervals to identify cancer recurrence.

What do my PSA Total test results mean?

PSA test results can be interpreted in a variety of ways, and the cutoff values used by different laboratories may differ.

Total PSA levels below 4.0 ng/ml are considered unlikely to indicate the existence of prostate cancer. Some argue that this limit should be reduced to 2.5 ng/ml in order to detect more prostate cancer cases. Others contend that this might result in more malignancies being diagnosed and treated that aren't clinically important.

Men with a total PSA level of more than 10.0 ng/ml are thought to be at a higher risk of prostate cancer.

Total PSA readings of 4.0 to 10.0 ng/ml may suggest prostate cancer, benign prostatic hyperplasia, or prostate inflammation. These problems, as well as an increase in PSA levels, are more common among the elderly. The "gray zone" is defined as total PSA levels between 4.0 and 10.0 ng/ml. The free PSA may be beneficial in this range.

Prostate cancers produce primarily complexed PSA rather than free PSA. Prostate cancer cells create more free PSA, which does not bind to proteins. As a result, when men in the gray zone have lower levels of free PSA, they have higher levels of cPSA and a higher risk of prostate cancer. When individuals have high amounts of free PSA but low cPSA, however, the danger is reduced. The ratio of free to total PSA can assist the patient and his healthcare professional in determining whether or not a prostate biopsy is necessary.

Additional analyses of PSA test results are occasionally utilized to improve the total PSA's efficacy as a screening tool. They are as follows:

• PSA velocity is the rate at which PSA concentrations fluctuate over time; if the PSA continues to climb rapidly over time, prostate cancer is more likely. If it rises quickly, the patient may be suffering from a more aggressive kind of cancer.
• PSA doubling time is a kind of PSA velocity that quantifies the rate at which the PSA concentration doubles.
• PSA density is a comparison of PSA concentration and prostate volume; if the PSA level is higher than one would predict given the size of the prostate, the likelihood of cancer is higher.
• PSA ranges adapted to a man's age—Because PSA values typically rise with age, it has been advocated that normal ranges be customized to a man's age.

The PSA level should start to drop with prostate cancer treatment, and should be very low or undetectable at the end of treatment. If concentrations do not drop to extremely low levels, the treatment is ineffective. Following treatment, the PSA test is repeated at regular intervals to check for recurrence of cancer. Because even small increases can be important, persons who are impacted should have their monitoring PSA tests done by the same laboratory each time to reduce testing variation.

A test known as "ultrasensitive PSA" may be helpful in detecting cancer persistence or recurrence after therapy. PSA is detected at significantly lower levels in this test than in regular PSA tests. Increases in PSA related to the persistence or return of cancer, it has been proposed, can be detected much sooner using this test. The results of this test, however, should be regarded with caution. Because the test is so sensitive, even when no cancer is present, minor rises in PSA levels can occur from one time to the next.

Is there anything else I should know about the Prostate Specific Antigen Total test?

The blood sample is normally taken before the DRE since the DRE can induce a brief increase in PSA.

PSA levels will be dramatically elevated following prostate procedure such as biopsy or excision. Before surgery or six weeks after manipulation, a blood test should be performed.

A brief increase in PSA level can be caused by strenuous physical activity that affects the prostate, such as cycling. Ejaculation within 24 hours of a PSA test can result in higher PSA values, thus it's best to avoid it.

Some chemotherapy medicines, such as cyclophosphamide and methotrexate, can raise or lower PSA levels in high dosages.

PSA levels may briefly rise in some men as a result of other prostate problems, particularly infection. According to a research, nearly half of men with high PSA levels saw their levels return to normal after a period of time. Before taking any further action, several authorities urge that a high PSA be repeated between 6 weeks and 3 months following the initial high PSA. If there is indication that the prostate is infected, some doctors will prescribe antibiotics.

Most Common Questions About the PSA Post Prostatectomy test:

Purpose and Applications

Why is the PSA Post Prostatectomy test ordered?

The PSA Post Prostatectomy test is typically ordered to monitor men after they've had a prostatectomy (surgical removal of the prostate) to ensure that prostate-specific antigen (PSA) levels remain undetectable or extremely low. Elevated levels after surgery could indicate the presence of remaining prostate cells or recurrence of prostate cancer.

How does the PSA Post Prostatectomy test differ from the regular PSA test?

While both tests measure the level of PSA in the blood, the PSA Post Prostatectomy test is specifically designed to detect very low levels of PSA which might be present after prostate removal. The regular PSA test, on the other hand, is used primarily as a screening tool for prostate cancer in men with an intact prostate.

Clinical Significance

If my PSA levels rise after a prostatectomy, does it mean my cancer has returned?

An increase in PSA levels after a prostatectomy could indicate a recurrence of cancer, but it's also possible that it reflects the presence of benign prostate cells left after surgery. It's crucial to discuss any rise in PSA with your healthcare provider to determine the best course of action.

What PSA level is considered "safe" or "normal" after a prostatectomy?

After a prostatectomy, the ideal PSA level should be undetectable or extremely low, usually less than 0.1 ng/mL. However, the exact "safe" level might vary depending on the specific test and laboratory standards.

Interpretation

What does an undetectable PSA level after prostatectomy indicate?

An undetectable PSA level post-prostatectomy usually indicates that the prostate has been entirely removed and there is no evidence of residual or recurrent prostate cancer at that time.

If my PSA Post Prostatectomy test results are slightly elevated, should I be concerned?

Any detectable PSA after prostatectomy can be a concern and should prompt a discussion with your healthcare provider. They might recommend additional tests, monitoring, or treatments depending on the situation.

Additional Considerations

How often should I undergo the PSA Post Prostatectomy test after surgery?

The frequency of testing can vary based on individual circumstances, but many urologists recommend checking PSA levels every 3-6 months for the first couple of years after surgery, then annually if the results remain undetectable or very low.

Can other conditions or factors cause a rise in PSA levels post-prostatectomy?

While a rise in PSA is generally concerning for possible prostate cancer recurrence, other factors such as prostatitis (inflammation of the prostate), benign prostate tissue left after surgery, or laboratory errors can also lead to elevated PSA levels. It's essential to consider all possibilities and work closely with your healthcare provider for accurate interpretation.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.