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PSA After Prostate Surgery: What the Numbers Mean

NEW YORK, NY--(Marketwired - Dec 18, 2013) - The widely used PSA (prostate-specific antigen) test measures a man's PSA level and, when consistently elevated, can indicate prostate cancer. After a definitive diagnosis, many men elect robotic prostate surgery for complete removal of the cancerous prostate gland. "In localized prostate cancer cases, a zero PSA and a cure are both highly obtainable through prostate removal, making it the optimal prostate cancer treatment," said David Samadi, MD, Chairman of Urology, Chief of Robotic Surgery at Lenox Hill Hospital. 

But what if the PSA isn't zero after prostate surgery? Without a prostate, what does a fluctuating PSA mean? 
"One elevated PSA test after surgery is not cause for alarm; do not panic," urges Dr. Samadi. "Keep in mind that whether before or after surgery, the PSA test is very sensitive. We never draw a straight line from one elevated test result to prostate cancer." 

Since the prostate gland is responsible for PSA production, a zero PSA is a widely accepted measure of robotic surgery treatment success. But as Dr. Samadi explains to his patients, PSA does not leave the body the minute the prostate does. Experts agree that by waiting two months post-surgery to test PSA level, a truer measure should be obtainable. If PSA is detected, the test is repeated over a series of intervals every few months. When the PSA disappears or stabilizes near zero, cancer-free assurance can be given. 

"The likelihood of prostate cancer recurrence is based on pre-surgery status and the clarity of surgical margins achieved during prostate removal," said Dr. Samadi. "When post-surgery PSA tests indicate consistent activity, we look at the doubling time. How fast and how much is the PSA rising? Then we know if further treatment is needed."

Prostate cancer recurrence after surgery is of greater risk to patients whose cancer was advanced at the time of diagnosis. In cases of seminal vesicle invasion or spread beyond the prostate gland, prostate cells that remain after surgery can gain momentum and begin producing enough PSA to indicate unwanted activity. Post-surgery PSA level fluctuations or increases require careful analysis of Gleason score and the time since prostate removal. Doubling time, the speed with which the PSA level doubles, is also a critical factor.

"Not all prostate cancer recurrences are the same," explains Dr. Samadi. "After collaborating with our team of oncologists and prostate cancer experts and reviewing all diagnostic factors, we can individualize secondary treatments to be most effective for the patient." 

When prostate cancer recurrence is deemed more aggressive, radiation therapy may be recommended. Dr. Samadi encourages patients to reserve radiation therapy for Plan B, as the one-two punch can be highly effective. Reversing the order of treatment, however, is very limiting. Surgery is rarely possible after radiation therapy. 

Men seeking counsel on the best treatment for prostate cancer cure, fluctuating post-treatment PSA levels, and long-term success are invited to submit a question directly to Dr. Samadi via www.roboticoncology.com.

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Call to Make an Appointment With Dr. David Samadi:

1-212-365-5000

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* The benefits of robotic surgery cannot be guaranteed as surgery is both patient and procedure specific. Previous surgical results do not guarantee future outcomes.
Testimonials
Robert, S

You are the bomb! That's what the young kids say today about something that is simply the best, over the top, outstanding.  I was your 3rd and last robotic prostatectomy on Wednesday, Dec. 5th at Mt. Sinai Hospital and you had a tough time locating the walnut-sized gland...

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Ezra R., Israel

שמי עזרא אני בן 51 והתגלה אצלי סרטן ערמונית לפני שמונה חודשים.מהרגע שהסרטן התגלה הבנתי שיש הרבה שיטות טיפול והיה מאד קשה להחליט על צורת הטיפול והנושא הצריך לעשות שיעורי בית יסודיים.

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Moshe T., Israel

לפני זמן קצר, כחודשיים אחרי שעברתי כריתה רדיקלית של בלוטת הערמונית בשיטה הרובוטית, בביצוע ד" דיויד סמאדי, מביה"ח "מאונט סיני" בניו יורק, שאל אותי אחד מחברי הטובים: "היום, בראייה לאחור, האם היית מחליט לעשות אותו דבר? אותה פרוצדורה? אצל אותו רופא?" "בדיוק אותו דבר!" עניתי מיד וללא כל היסוס. לא הייתי צריך לחשוב אפילו שנייה.

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Len F.

On Oct. 1, 2009, I was diagnosed with prostate cancer.  I had anticipated that the biopsy findings would be negative and I was rather shocked with this diagnosis.

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