Table of ContentsView AllTable of ContentsPSA ImportanceDetecting a RelapseWhat Guides Treatment
Table of ContentsView All
View All
Table of Contents
PSA Importance
Detecting a Relapse
What Guides Treatment
If you or someone you’re close to has prostate cancer, you’ll hear a lot about thePSA blood testand the PSA doubling time (PSADT). PSA helps medical providers screen for and diagnose prostate cancer at an early stage.
But there’s more to the test than just that. The PSADT—a measurement of how quickly the PSA is increasing—is especially important after you’ve been treated for prostate cancer.
This article will walk you through why the PSA doubling time is so significant, how your doctors will use it to monitor for recurrence, and what factors will play a role in how a recurrence is treated.
What is PSA?
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Why PSA Is Important
PSA plays many different roles. The most common is determining prostate cancer risk.
PSA is also used to help determine the stage of a newly diagnosed prostate cancer. Staging is a measurement of how advanced the disease is.
The PSA doubling time can also detect a relapse of cancer after treatment with surgery or radiation.
The time it takes for PSA blood levels to double gives your medical team an insight into how aggressive your prostate cancer will be in the future.
That can guide your treatment plan, which may include:
RecapThe PSA and PSADT are important for prostate cancer screening, diagnosis, and—in the case of a relapse—determining the best treatment plan.
Recap
The PSA and PSADT are important for prostate cancer screening, diagnosis, and—in the case of a relapse—determining the best treatment plan.
Prostate Cancer Staging, Grading, and Risk
PSA is useful for detecting a relapse of prostate cancer after surgery or radiation. After prostate cancer surgery, PSA is normally undetectable, and even small rises could point to a recurrence.
After curative radiation, the PSA generally stays under 1.0 long-term. However, there are exceptions. Sometimes, the PSA level drops slowly after radiation and it may take years to reach its lowest point.
Younger people may have a short-term PSA rise that’s not cancer-related. That’s more common after the seed-implant type of radiation. This temporary rise is called a “PSA bump” or “bounce.” It can develop between one and four years after treatment.
It may be linked with anti-cancer activity in the immune system, which is a good thing. However, it’s sometimes mistaken for a recurrence, which can lead to fear, stress, and even unnecessary hormone therapy.
Treatments for Prostate Cancer
When cancer comes back, the PSADT is an indicator of how fast it’s growing.
Your age, other illnesses, and overall health will also be considered.
PSADT
The PSA doubling time has a big influence on treatment. There are treatments for men whose prostate cancer had recurred and is getting worse despite anti-hormonal treatment with Lupron Depot.
Treatments for recurrence of prostate cancer that hasn’t spread:
Original Risk Category
Your original risk category will also play a role in treatment decisions.
Risk categories:
The higher the risk, the more aggressive the treatment. For example, if you were originally low risk, your treatment may include either cryotherapy, radiation, or Lupron Depot alone if cancer is confined to the prostate (after radiation) or the prostatic bed (after prior surgery).
If you were originally in the high-risk category, treatment may mean Lupron Depot plus pelvic lymph node radiation.
RecapAfter surgery or radiation, medical providers watch for a cancer relapse with PSA and PSADT test results. Those numbers plus your original risk category are considered together when deciding what treatment course to follow—the faster the PSADT and the higher your risk category, the more aggressive treatment will be.
After surgery or radiation, medical providers watch for a cancer relapse with PSA and PSADT test results. Those numbers plus your original risk category are considered together when deciding what treatment course to follow—the faster the PSADT and the higher your risk category, the more aggressive treatment will be.
Tumor Location
If you have a rising PSA after surgery or radiation, your doctor will likely order imaging studies to find the location of your cancer recurrence.
Common scans are:
Cancer in the prostate or prostate bed is considered a local recurrence. Cancer that’s spread outside of that area is called metastatic.
Treatment of metastatic recurrence depends on where it is and many other factors.
With a local relapse, disease suppression with Lupron Depot is an option.
That’s especially true if you have a:
Lupron Depot alone is almost never a cure, but it often controls the disease for more than a decade.
Insurance Coverage
What to Expect During a PET Scan
Post-Surgery
Generally, if you were low-risk or intermediate-risk before surgery and develop a PSADT of between six and 12 months, your recurrence has a good chance of being cured with radiation treatment to theprostate bed.
Radiation is most effective when the PSA level is low and the PSADT is long without evidence of spread/metastases on imaging studies.
If you want to avoid radiation side effects, another option is to suppress the PSA with an intermittent, six-month course of Lupron Depot.
If your PSA doubling time is faster—for example, under six months—your medical provider is likely to recommend pelvic-node radiation plus Lupron Depot for as long as 12 to 18 months.
If you were high-risk before surgery, treatment will often be node radiation with 12 to 18 months of Lupron Depot. Your medical provider may suggest adding more powerful drugs like Zytiga, Xtandi, or Taxotere.
Post-Radiation
For a rising PSA after radiation, a popular approach is cryosurgery (freezing cancer cells). Newer scans help the cryosurgeon focus on cancerous areas, rather than treating the whole prostate.
This is called focal cryotherapy. It offers much fewer side effects than freezing or removing the whole gland.
Another alternative is prompt treatment with Lupron Depot. This can suppress the local disease.
It’s considered reasonable when:
If you were originally high risk, a local relapse should be treated aggressively with cryosurgery or seed implantation. Lupron Depot alone is less likely to work.
The prostate is rarely removed after radiation, due to high rates ofincontinenceanderectile dysfunction.
RecapOncologists and other medical providers use multiple scans, including some newer types, to find where cancer has recurred. Once it’s located and there is no evidence of metastases, the PSA, PSADT, original risk category, and other factors are used to determine treatment.Treatment courses depend largely on whether your original cancer was treated with surgery or radiation.After surgery, radiation and Lupron Depot are options.After radiation, cryotherapy or Lupron Depot are common choices.Lupron Depot alone is recommended when PSA and PSADT indicate more aggressive cancer.
Oncologists and other medical providers use multiple scans, including some newer types, to find where cancer has recurred. Once it’s located and there is no evidence of metastases, the PSA, PSADT, original risk category, and other factors are used to determine treatment.Treatment courses depend largely on whether your original cancer was treated with surgery or radiation.After surgery, radiation and Lupron Depot are options.After radiation, cryotherapy or Lupron Depot are common choices.Lupron Depot alone is recommended when PSA and PSADT indicate more aggressive cancer.
Oncologists and other medical providers use multiple scans, including some newer types, to find where cancer has recurred. Once it’s located and there is no evidence of metastases, the PSA, PSADT, original risk category, and other factors are used to determine treatment.
Treatment courses depend largely on whether your original cancer was treated with surgery or radiation.
Summary
Deciding on a treatment for aPSA relapseis complex. The choice is based on factors including your original risk category, PSA doubling time, and scan findings. The location of recurrent cancer may remain uncertain, even with the best scans.
Treatment with cryosurgery or radiation alone is reasonable when:
Microscopic metastases in the pelvic nodes don’t always show up on scans.
They’re more likely if:
In these situations, pelvic lymph node radiation plus an extended course of Lupron Depot is usually recommended.
A Word From Verywell
Cancer is always serious, but the overall outlook of prostate cancer is often positive. Most people with prostate cancer have a good 15-year prognosis.
Sometimes, prostate cancer can be cured. Even when it’s not, it can be controlled for years and even decades.
Keep up with your monitoring tests, including the PSA doubling time, is a key component of staying well in the long term.
Prostate Cancer Causes and Risk Factors
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Prostate-specific antigen (PSA) test.National Institutes of Health, National Cancer Institute.Prostate-specific antigen (PSA) test.Dana-Farber Cancer Institute.How we diagnose prostate cancer.Kishan AU.PSA bounce, prognosis, and clues to the radiation response.Prostate Cancer Prostatic Dis. 2021;10.1038/s41391-021-00387-4. doi:10.1038/s41391-021-00387-4Howard LE, Moreira DM, De Hoedt A, et al.Thresholds for PSA doubling time in men with non-metastatic castration-resistant prostate cancer.BJU Int. 2017;120(5B):E80-E86. doi:10.1111/bju.13856Schweizer MT, Huang P, Kattan MW, et al.Adjuvant leuprolide with or without docetaxel in patients with high-risk prostate cancer after radical prostatectomy (TAX-3501): important lessons for future trials.Cancer. 2013;119(20):3610-3618. doi:10.1002/cncr.28270Prostate Cancer Foundation.Risk groups.Songmen S, Nepal P, Olsavsky T, Sapire J.Axumin positron emission tomography: Novel agent for prostate cancer biochemical recurrence.J Clin Imaging Sci.2019;9:49. doi:10.25259/JCIS_139_2019Kitajima K, Murphy RC, Nathan MA, et al.Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil.J Nucl Med. 2014;55(2):223-232. doi:10.2967/jnumed.113.123018Gupta I, Freid B, Masarapu V, et al.Transrectal subharmonic ultrasound imaging for prostate cancer detection.Urology. 2020;138:106-112. doi:10.1016/j.urology.2019.12.025Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S.Management of biochemical recurrence after primary curative treatment for prostate cancer: a review.Urol Int. 2018;100(3):251-262. doi:10.1159/000481438Hofman MS, Lawrentschuk N, Francis RJ, et al.Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study.Lancet. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7Harvard Medical School.Immediate radiation when PSA levels spike after prostate cancer surgery helps reduce risk of recurrence.Ahdoot M, Lebastchi AH, Turkbey B, Wood B, Pinto PA.Contemporary treatments in prostate cancer focal therapy.Curr Opin Oncol. 2019;31(3):200-206. doi:10.1097/CCO.0000000000000515Additional ReadingFenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J.Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018;319(18):1914-1931. doi:10.1001/jama.2018.3712
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Prostate-specific antigen (PSA) test.National Institutes of Health, National Cancer Institute.Prostate-specific antigen (PSA) test.Dana-Farber Cancer Institute.How we diagnose prostate cancer.Kishan AU.PSA bounce, prognosis, and clues to the radiation response.Prostate Cancer Prostatic Dis. 2021;10.1038/s41391-021-00387-4. doi:10.1038/s41391-021-00387-4Howard LE, Moreira DM, De Hoedt A, et al.Thresholds for PSA doubling time in men with non-metastatic castration-resistant prostate cancer.BJU Int. 2017;120(5B):E80-E86. doi:10.1111/bju.13856Schweizer MT, Huang P, Kattan MW, et al.Adjuvant leuprolide with or without docetaxel in patients with high-risk prostate cancer after radical prostatectomy (TAX-3501): important lessons for future trials.Cancer. 2013;119(20):3610-3618. doi:10.1002/cncr.28270Prostate Cancer Foundation.Risk groups.Songmen S, Nepal P, Olsavsky T, Sapire J.Axumin positron emission tomography: Novel agent for prostate cancer biochemical recurrence.J Clin Imaging Sci.2019;9:49. doi:10.25259/JCIS_139_2019Kitajima K, Murphy RC, Nathan MA, et al.Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil.J Nucl Med. 2014;55(2):223-232. doi:10.2967/jnumed.113.123018Gupta I, Freid B, Masarapu V, et al.Transrectal subharmonic ultrasound imaging for prostate cancer detection.Urology. 2020;138:106-112. doi:10.1016/j.urology.2019.12.025Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S.Management of biochemical recurrence after primary curative treatment for prostate cancer: a review.Urol Int. 2018;100(3):251-262. doi:10.1159/000481438Hofman MS, Lawrentschuk N, Francis RJ, et al.Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study.Lancet. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7Harvard Medical School.Immediate radiation when PSA levels spike after prostate cancer surgery helps reduce risk of recurrence.Ahdoot M, Lebastchi AH, Turkbey B, Wood B, Pinto PA.Contemporary treatments in prostate cancer focal therapy.Curr Opin Oncol. 2019;31(3):200-206. doi:10.1097/CCO.0000000000000515Additional ReadingFenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J.Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018;319(18):1914-1931. doi:10.1001/jama.2018.3712
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Prostate-specific antigen (PSA) test.National Institutes of Health, National Cancer Institute.Prostate-specific antigen (PSA) test.Dana-Farber Cancer Institute.How we diagnose prostate cancer.Kishan AU.PSA bounce, prognosis, and clues to the radiation response.Prostate Cancer Prostatic Dis. 2021;10.1038/s41391-021-00387-4. doi:10.1038/s41391-021-00387-4Howard LE, Moreira DM, De Hoedt A, et al.Thresholds for PSA doubling time in men with non-metastatic castration-resistant prostate cancer.BJU Int. 2017;120(5B):E80-E86. doi:10.1111/bju.13856Schweizer MT, Huang P, Kattan MW, et al.Adjuvant leuprolide with or without docetaxel in patients with high-risk prostate cancer after radical prostatectomy (TAX-3501): important lessons for future trials.Cancer. 2013;119(20):3610-3618. doi:10.1002/cncr.28270Prostate Cancer Foundation.Risk groups.Songmen S, Nepal P, Olsavsky T, Sapire J.Axumin positron emission tomography: Novel agent for prostate cancer biochemical recurrence.J Clin Imaging Sci.2019;9:49. doi:10.25259/JCIS_139_2019Kitajima K, Murphy RC, Nathan MA, et al.Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil.J Nucl Med. 2014;55(2):223-232. doi:10.2967/jnumed.113.123018Gupta I, Freid B, Masarapu V, et al.Transrectal subharmonic ultrasound imaging for prostate cancer detection.Urology. 2020;138:106-112. doi:10.1016/j.urology.2019.12.025Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S.Management of biochemical recurrence after primary curative treatment for prostate cancer: a review.Urol Int. 2018;100(3):251-262. doi:10.1159/000481438Hofman MS, Lawrentschuk N, Francis RJ, et al.Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study.Lancet. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7Harvard Medical School.Immediate radiation when PSA levels spike after prostate cancer surgery helps reduce risk of recurrence.Ahdoot M, Lebastchi AH, Turkbey B, Wood B, Pinto PA.Contemporary treatments in prostate cancer focal therapy.Curr Opin Oncol. 2019;31(3):200-206. doi:10.1097/CCO.0000000000000515
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Prostate-specific antigen (PSA) test.
National Institutes of Health, National Cancer Institute.Prostate-specific antigen (PSA) test.
Dana-Farber Cancer Institute.How we diagnose prostate cancer.
Kishan AU.PSA bounce, prognosis, and clues to the radiation response.Prostate Cancer Prostatic Dis. 2021;10.1038/s41391-021-00387-4. doi:10.1038/s41391-021-00387-4
Howard LE, Moreira DM, De Hoedt A, et al.Thresholds for PSA doubling time in men with non-metastatic castration-resistant prostate cancer.BJU Int. 2017;120(5B):E80-E86. doi:10.1111/bju.13856
Schweizer MT, Huang P, Kattan MW, et al.Adjuvant leuprolide with or without docetaxel in patients with high-risk prostate cancer after radical prostatectomy (TAX-3501): important lessons for future trials.Cancer. 2013;119(20):3610-3618. doi:10.1002/cncr.28270
Prostate Cancer Foundation.Risk groups.
Songmen S, Nepal P, Olsavsky T, Sapire J.Axumin positron emission tomography: Novel agent for prostate cancer biochemical recurrence.J Clin Imaging Sci.2019;9:49. doi:10.25259/JCIS_139_2019
Kitajima K, Murphy RC, Nathan MA, et al.Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil.J Nucl Med. 2014;55(2):223-232. doi:10.2967/jnumed.113.123018
Gupta I, Freid B, Masarapu V, et al.Transrectal subharmonic ultrasound imaging for prostate cancer detection.Urology. 2020;138:106-112. doi:10.1016/j.urology.2019.12.025
Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S.Management of biochemical recurrence after primary curative treatment for prostate cancer: a review.Urol Int. 2018;100(3):251-262. doi:10.1159/000481438
Hofman MS, Lawrentschuk N, Francis RJ, et al.Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study.Lancet. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7
Harvard Medical School.Immediate radiation when PSA levels spike after prostate cancer surgery helps reduce risk of recurrence.
Ahdoot M, Lebastchi AH, Turkbey B, Wood B, Pinto PA.Contemporary treatments in prostate cancer focal therapy.Curr Opin Oncol. 2019;31(3):200-206. doi:10.1097/CCO.0000000000000515
Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J.Prostate-specific antigen-based screening for prostate cancer: evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018;319(18):1914-1931. doi:10.1001/jama.2018.3712
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