DEAR DR. ROACH:
I am a 74-year-old man. I was diagnosed with prostate cancer in 2019 and had my prostate removed in 2021. My PSA level was 0.39 on my three-month follow-up visit, but it has increased to 1.460. In my mind, if the procedure was successful, the PSA should be zero. I had a PET scan in May 2022, showing that the gland was completely gone. I have complete confidence in my urologist, but I’m just wondering if there is something he may not be telling me. — E.B.
ANSWER:
Prostate cancer is often treated with surgery, with the intent to cure the cancer. About 30% of the time, and usually within five years of treatment, the PSA level will rise. The fact that your PSA level was not zero after surgery suggests some prostate tissue was left. However, I can’t answer whether this is cancerous or not.
A positron emission tomography (PET) scan looks for metabolically active tumors. About 80% of prostate cancers will take up the dye used in PET scans, fluorodeoxyglucose, and sometimes normal prostate tissue will as well. The negative PET scan is good news, but does not definitively answer whether you have recurrence of prostate cancer or not, or even if there is any residual amount of prostate tissue left.
However, the rising level (yours has doubled twice in two years) suggests there is prostate tissue somewhere in your body. When a PSA level doubles in less than three months, that’s a sign that aggressive cancer has returned. Your doubling time is roughly one year. Men with a doubling time greater than three months had an excellent prognosis — a less than 1% prostate cancer mortality rate after eight years.
Your urologist has other information than can help determine how worried you need to be about the PSA level rising after surgery, and it’s important to have a frank discussion.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to
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