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Roscoe Nelson, MD

Prostate Cancer Blog


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What happens if my PSA rises after surgery?

Monday April 21, 2014

So you were diagnosed with prostate cancer and made the decision to have your prostate removed.  Hopefully your PSA decreased to <0.1 and has remained there.  Unfortunately it doesn't stay undetectable for everyone.  The higher the grade of cancer and the higher the baseline PSA is the greater the risk of cancer recurrence.  This is what we refer to as PSA or "Biochemical Recurrence".


If your prostate was removed and your PSA is climbing it means there are prostate cells still in your body.  These usually are cancer cells.


Where is the cancer?


There are several places the cancer cells can be hiding.  They can be leftover in the area the prostate was removed from.  Sometimes they are in lymph nodes or in bones.  The level of PSA and rate of rise will often help your urologist know how to find it.


When the PSA first rises it is often difficult to find the cancer.  If your PSA is <0.5 it usually doesn't show up on exam, Cat Scan or bone scan.  As the PSA rises the chances go up of finding it.  Some doctors use more sophisticated tests including the Sodium Flouride (NaF) PET scan which is more sensitive at finding bone metastases.  Another up and coming study is the Carbon-11 Acetate PET scan.  Often these more sensitive tests are not covered by insurance.


Clues to Where It's At


If the PSA starts to rise then the first place to look is the original pathology report.  Was there a positive margin?  If there was a positive margin then it is likely that some of the cancer cells are sitting near where the prostate was removed.


If the PSA rises quickly with a doubling time of less than 8 months it is more likely to be in a metastatic location (bone or lymph node).  The greater the time after prostatectomy it starts to go up and the slower it rises the better the prognosis.


What's My Next Move?


If your PSA is rising after radical prostatectomy see your urologist.  You need an exam and likely some imaging.   If the cancer cells are still in the prostatic bed then it is possible to still be cured with radiation to that area.  If the cancer has moved out of the area you may need to be treated with hormonal therapy.  Depending on your age and rate of rise of PSA, active surveillance may be your best option.  Like most prostate cancer questions, one size does not fit all.  Talk to your family, make a list of questions and then talk to your doctor.  Remember that just because the PSA has started to rise doesn't mean you have lost the battle or the war.


Your Surgeon May Be a Robot

Thursday March 1, 2012

According to a new study, robot-assisted radical prostatectomies now outnumber other forms of prostate cancer surgery in the United States. Nearly 61 percent of prostatectomies were performed by robotic devices between 2008 and 2009.

What's more, robotic prostate surgery appears to have fewer complications and shorter hospital stays than traditional open prostatectomies, according to the lead researcher, Dr. Quoc-Dien Trinh, of Vattikuti Urology Institute, Henry Ford Health System, in Detroit. He reported his finding at the European Association of Urology 27th Annual Congress, in Paris.

The procedure has grown exponentially in recent years - from 9 percent of prostatectomies  in 2003 to 61 percent, according to Medscape Medical News. In robot-assisted surgery, a surgeon operates mechanical arms to make smaller, more precise incisions. The first robot-assisted prostate surgery was performed only in 2000.

Learn more about robot-assisted surgery at About.com.

What is High-Dose Rate Brachytherapy?

Monday November 28, 2011

There are a number of treatment choices for men who are newly diagnosed with prostate cancer.  Radiation therapy has long been one of the mainstays of prostate cancer treatment and there have been many advances within the field of radiation oncology over the last several years.

One notable advance has been the development of high-dose rate brachytherapy for treatment of localized prostate cancer.

You can read all about high-dose rate brachytherapy - its advantages and disadvantages here.

Study Finds Prostate Cancer Is Less Common in Men With HIV

Saturday November 26, 2011

A new study recently published in the medical journal Cancer Epidemiology, Biomarkers and Prevention has shown that many types of cancer are more common in men who are infected with HIV, the virus that causes AIDS.

The study also found that prostate cancer was actually less commonly diagnosed in men with HIV.

The authors attributed the increased rates of some types of cancers (such as lung cancer) to lifestyle choices and the weakened immune system of many HIV patients.  It is unclear as to why prostate cancer is less common in men with HIV.

What to Know About "Watchful Waiting" for Prostate Cancer

Friday November 25, 2011

"Watchful waiting" is today accepted as a legitimate alternative for men who have been diagnosed with prostate cancer who may not need to be immediately treated for their disease.   It is sometimes known as "active surveillance" and involves carefully monitoring for the development of worsening or spreading prostate cancer - rather than actively treating the cancer.

This is obviously a controversial option in some doctors' and patients' eyes, but it does have a role in the correct circumstances.

You can read all about "watchful waiting" here.

What Does Your Prostate Cancer "Stage" Mean?

Thursday November 24, 2011

When prostate cancer is diagnosed, your doctors will likely put you through a serious of tests to determine the "stage" of your prostate cancer.

Prostate cancer's stage simply refers to how far the cancer has extended or spread at the time of diagnosis.  Staging prostate cancer is essential for determining the correct treatment.

There is much more to learn about prostate cancer staging.

New Prostate Cancer Drug Shown to Slow Development of Bone Metastases

Tuesday November 22, 2011

A new study has shown that the drug denosumab can slow the development of prostate cancer metastases in the bones.  The study was recently published in the medical journal, Lancet.  The article's authors showed that denosumab slowed the development of bony metastases by roughly 4 months in men with advanced prostate cancer.

This may not sound like a huge advance in treatment, but it does represent another significant step forward in treating men with prostate cancer that has become resistant to hormone therapy.  There currently are not a great deal of treatment options for men who fall into this category.

The results of the study are important because prostate cancer has a propensity to spread to the skeleton, especially in men whose cancer has become resistant to hormone-deprivation treatment (ie. hormone therapy).  These metastases can cause pain as well as weaken the bones and lead to fractures.

The study did show that men taking denosumab had a higher rate of serious adverse side effects like osteonecrosis of the jaw and low calcium levels.

Prostate Cancer Found in Ancient Egyptian Mummy

Monday November 14, 2011

Researchers using advanced imaging tests recently concluded that an ancient Egyptian mummy, likely died with metastatic prostate cancer.

The study, recently published in the Journal of Paleopathology, found that the mummy - thought to be a man in his 50s - had numerous sclerotic spots throughout the bones of his pelvis and lower spine that were most consistent in appearance with metastases from prostate cancer.

The researchers, some of whom are physicians, used advanced multi-detector CT scans to analyze the mummy and find the prostate cancer metastases.  Interestingly, they also discovered that the man had severe lower back arthritis as well as scoliosis (curvature of the spine).

National Lacrosse League Players Participating in Movember

Thursday November 10, 2011

Several members of the National Lacrosse League have begun growing moustaches (or "mos") as a part of the Movember campaign to raise awareness about prostate cancer and raise funds for prostate cancer research.

The Toronto Rock lacrosse team has a Movember website if you're interested in learning more or donating.

Prostate Surgery Complications Lower at Teaching Hospitals

Monday November 7, 2011

A new study has shown that teaching hospitals (those that take part in the training of medical students, physicians-in-training, or other healthcare professionals) have overall lower rates of complications following radical prostatectomy for prostate cancer.

The research, recently published in the Journal of Urology, reviewed roughly 90,000 radical prostatectomies done across the United States and showed that, on average, men who had their surgery at an academic (teaching) hospital had less need for blood transfusions following surgery and shorter overall stays in the hospital.

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