Treatment after Prostate Cancer
Prostatectomy & PSA

If a man has had surgery to remove the prostate (prostatectomy) PSA should be undetectable. If the man has had radiation or cryosurgery treatment, he will probably still have some viable prostate tissue left. So it may be normal for these men to have PSA in the blood. But the amount of PSA should be fairly low and the amount should be stable from test to test.

If a man has a high PSA reading after radiation or cryosurgery, and it remains high or increases in subsequent tests, then we know that all of the cancer was not killed, or that it had metastasized before treatment. This is a case of Prostate Cancer Recurrence (PSA numbers <>0 indicate this).

Ultra-sensitive PSA Test

Undetectable PSA after prostatectomy is perfect, this is after all the main goal of this radical intervention: no prostate=no PSA. However, if post treatment PSA levels are still there, then we know that the cancer had metastasized, and this is a sign prostate cancer is spreading after treatment. Metastatic cells are the same initial prostate cancer cells, no matter whether they have set up a colony in the lymph nodes or vertebra or lungs or wherever, and this calls for treatment after prostate cancer . So they will continue to pour PSA into the blood stream. Also, if a PSA blood tests shows that the PSA levels are rising after a prostatectomy , then we know that there are cancer cells still in the body somewhere.

The normal PSA test is not very sensitive, and it can detect only down to about 0.2 ng/ml. This is a good accuracy for pre-treatment PSA tests, for these levels can be influenced by many causes. But after treatment/intervention, especially after radical prostatectomy, there should be no PSA in the blood stream.

Dr. Stamey et al at Stanford University devised an ultra-sensitive test that may be ten times more sensitive than the normal Hybritech test. This test can show if the PSA is rising long before it becomes high enough to be detected by the normal PSA test (several months before). If the ultra-sensitive PSA test shows PSA activity, then new treatments options can be considered.

Following is a post from the internet by Charles Clausen about the ultrasensitive PSA tests:

There are two principal manufacturers of "superduper-ultrasensitive" assays, both of which use a chemiluminescent technique:

• Coming/Nichols, 33608 Ortega Hwy., San Juan Capistrano, CA 92690 1-800-642-4657
• Diagnostic Products, 5700 West 96th Street, Los Angeles, CA 90045 1-800-372-1782

The Nichols assay reports values down to 0.02, but can read values as low as 0.007. The Diagnostic Products Immulite assay reports values down to 0.04, but the "Immulite 3rd Generation" assay, which is expected to receive FDA approval, can readvalues down to O.003, and would, I presume, report values equal to or lower than the Nichols assay.

An interesting paper about the Nichols assay by Dr. Stamey of Stanford and the staff of the Nichols Institute can be obtained by phoning the Nichols number above. In this paper, it is stated that the Nichols assay values correlate very closely to those of the Hybritech and Yang assays. They say that their assay should be useful for detecting recurring PCa in post-prostatectomy patients because it allows more lead time in detecting a rising PSA. For this purpose, Dr. Stamey recommends testing every three months, until a PSA >0.07 is detected, then testing should be monthly, "to establish a log linear rise to levels >0.1 ng/mL".

If a "progressive exponential increase" is detected, you know the PCa is back, but if the >0.07 proves to be a one time elevation, it is o.k. to resume testing every three months. The paper states, "serial measurements of serum PSA using an ultrasensitive essay can accelerate detection of recurrence in prostatectomized patients by many months."

From what I have been able to gather, both of these assays are available at the same cost as conventional assays.

Charles Clausen, SW Oregon cclausen@magick.net

at age 56, 1/94 Dx: PSA 9.9, Gleason 3+4; 3/94 Tx: RP at UCSF, Dx: pT3aNl; thru 7/94 PSA <0.1, 10/94 PSA 0.1 (Abbott IMX); 1/95 to 12/95 Tx: CHT, 2/95 thru 3/96 PSA undetectable (IMX); 6/96 PSA 0.02, 9/96 PSA 0.09 (Immulite 3rd generation) >