Oncology (General Cancer)/prostate cancer

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QUESTION: My husband had robotic prostatectomy 4 months ago. His PSA test is 0.1. Shouldn't it be 0.0? We know someone who had the same surgery with the same Dr and his first results were 0.2 and the surgeon said it was fine. Well, 3 years later this person is having radiation treatments. My real question is this: should be go right now to an oncologist or wait to see if the levels stay this low? My husband had cancer in both sides but they said it wasn't in the borders and not in the lymph nodes. His Gleason Scores were 6 in 2 of the samples and 7 in the third. Three out of 12 were cancerous. I want to make sure he is cancer free. My husband is 59 years old.
Thanks.

ANSWER: A PSA of 0.1 is a little concerning, but there are other tissues in the body that make a little bit of PSA, so even without a prostate, some men still show a tiny bit.  I would suspect that there are no tests that could show if he still has any cancer in his body with the PSA that low.  Robotic surgery doesn't always remove all of the prostate tissue; in fact, sometimes a little normal prostate tissue is left in areas where the surgeon thinks it may be too risky to dig deeper.  So the best course of action right now is to continue to monitor the situation.  If the PSA is stable, or increases very very slowly, your husband probably doesn't have anything to worry about. (we think that if the doubling time of the PSA is greater than one year, a patient probably won't die of prostate cancer).  I hope this information helps.  

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QUESTION: To clarify, you are saying just careful watching at this point? There are no other tests to see if the cancer has spread? His PSA score had not doubled when our Dr sent him for testing to begin with, but it had jumped from 4.?? to 6.?? and the jumped started the testing. He was only given the biopsy so should he have had a bone scan or other tests? Also, on his pathology report it said that one lymph node had looked cancerous until further testing was done and showed it was not cancer. His father had prostate cancer but later in life. Thanks so much for your help.

Answer
With an extremely low PSA score (like 0.1) we would expect that the amount of prostate tissue would be so small as to be undetectable.  A change in a PSA scare from 4 to 6 might very well trigger further investigation in a 59 year old.  A rectal exam and a transrectal ultrasound would be done, and that might indeed demonstrate a nodule, and the rest is as happened.  As for a bone scan, we do them if the stage of the cancer is high (and it wasn't in his case) or if there is an elevation in alkaline phosphatase, or if there are bone symptoms.  Obviously if there is involvment of the bone, it isn't a curable condition, although it can often be managed for a very long time.  There are some experts you would at this point do a bone scan and an extensive study of the pelvis and abdomen with CT and/or MRI, and if nothing at all was found, offer pelvic radiation.  There is some evidence that this reduces the risk of recurrence by about 25 percent.  However, there isn't good evidence that it prolongs life, and there are some obvious downsides to this approach.  I'd see what the PSA looks like in two or three months.  If it has gone up a little I'd think about pelvic radiation, but again, we don't know that it saves lives.  I know you are concerned but there is only so much that can be done now.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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