Q: Can PSA levels increase after the prostate has been removed?
Yes. If prostate surgery was performed to treat benign (noncancerous) prostatic hyperplasia (BPH), the entire prostate is not removed. The prostate gland can regrow. As the prostate regrows, the level of prostate-specific antigen (PSA) can increase. PSA is a protein excreted both by benign tissue and as a result of the presence of prostate cancer – i.e., all men have detectable levels of PSA in their blood. So, a rising PSA level can result either from the regrowth of benign prostate tissue if you have had surgery for BPH or from the presence of prostate cancer.
If the prostate gland was totally removed to treat prostate cancer, a new rise in the PSA level may indicate a recurrence of the tumor. Additional tests would then be needed to determine the cause of the increased PSA level.
Q: Should I choose radiation therapy, radical surgery, hormone therapy, or "active surveillance" for treatment of my prostate cancer?
The type of treatment selected is mostly a matter of patient choice. You’ll want to consider the pros and cons of each option relative to your own situation and how aggressive and advanced your cancer is. As you begin your decision-making process, here are some issues to think about:
- Ask your doctor about the stage and grade of your cancer. This will give you information on how aggressive your cancer is. With this information, you and your doctor can discuss the risk that your cancer poses to your well-being and longevity, how well each treatment option might work in your situation and what the treatment side effects might be.
- Consider your age and health. Younger patients in their 40s and 50s with decades of life ahead may choose to treat the cancer aggressively. Cancer discovered in men in their 70s is likely to be slow-growing and may not have time to impact their life before they would die of other causes. Poor health adds to the complexity and makes treatment more risky.
- Think about your quality of life after treatment. Radiation can cause impotence and other urinary and rectal symptoms. Surgery can cause impotence and incontinence. So there are some difficult trade-offs to make in the face of uncertainty. Some men fear their sex lives may change, others are more fearful of dying or the anxiety of untreated cancer and prefer treatment despite the potential side effects.
- Make sure you are getting balanced and impartial information. If your doctor is a surgeon, you may want to talk with a radiation therapist, and vice versa. Make sure you feel comfortable discussing all of your options with all of your doctors and that they have taken the time to answer all of your questions. You should also do your own research and not just rely on your doctor’s opinion. Consult with your doctors armed with your questions. It is important to inquire about your doctor's personal expertise and experience in treating cancers like yours, as this is an important determinant of a successful outcome.
- Ask yourself how well you tolerate uncertainty and repeated doctor’s visits to deal with your cancer. If you are considering "active surveillance", can you deal with knowing that you have an untreated cancer inside your body? Will you follow through with office visits to your doctor for repeat testing? Would more aggressive treatment fit your personality and anxiety level?