“Most patients who have undergone radical prostatectomy surgery for the treatment of prostate cancer, performed either robotically or through an open approach, are followed after surgery with PSA blood testing, typically beginning about six weeks after surgery.

 

Using a standard PSA blood test, an undetectable PSA level reported to the lower limit of most assays (<0.1 ng/mL) has typically been accepted as indication that a patient is cancer-free, however up to 20 – 30% of patients who initially achieve this low level will go on to develop a rising PSA level indicative of prostate cancer recurrence at some future date.  This risk of future prostate cancer recurrence often leads to patients experiencing “PSA anxiety” with each follow up PSA test, a phenomena in which patients worry about possible prostate cancer recurrence as each subsequent follow up PSA is obtained, even years after surgery.  However, in a study reported last year, we demonstrated that an ultrasensitive PSA assay that reports results down to <0.003 ng/mL enables patients with prostate cancer recurrence to be identified well before the less accurate PSA test can identify them. Further, the additional lead time has provided the opportunity to treat recurring patients with salvage radiation therapy when the PSA is lower and the cancer is more likely to respond favorably.  For example, in our experience, patients who achieve an ultrasensitive PSA level of =0.01 by six weeks after surgery have a 99.2% chance of prostate cancer cure even with long-term follow up after radical prostatectomy.  Achieving such a low result at the first followup visit may lessen “PSA anxiety” experienced by patients down the road.  On the other hand, patients who fail to achieve an ultrasensitive PSA level of =0.01 are at significantly higher risk of BCR and should be followed more closely so that early intervention with salvage radiotherapy may be offered, when it is likely to be more effective.”