PSA monitoring after radical prostatectomy

Written by: Mr Neil Haldar
Edited by: Robert Smith

If you decide on having a radical prostatectomy, you will require monitoring post-surgery to check the results of the procedure and to ensure no cancer cells remain.

We found out from leading urologist, Mr Neil Haldar, about some of the measures should be taken once surgery is completed, what exactly undetectable PSA means and how recurrent cancer cells can be located.

Follow up after radical prostatectomy

The prostate gland, seminal vesicles and any lymph nodes removed will be sent to a pathologist to be looked at under a microscope. The results can give a clearer idea of how aggressive the prostate cancer might be, the grade, and whether it has spread beyond the confines of the prostate, the stage.

A ''positive surgical margin'' means there are cancer cells on the edge of the tissue removed. It leaves the possibility that some cancer cells may have been left behind, requiring further treatment in the future.

A ''negative or clear surgical margin'' means that the tumour removed was surrounded by a layer of healthy tissue, suggesting that all the tumour has been removed.

What is undetectable PSA after radical prostatectomy?

After the surgical a radical prostatectomy, the prostate specific antigen (PSA) drops to virtually undetectable levels, (less than 0.05), depending on the lab performing the PSA test. This reading is effectively zero, but given the limited sensitivity of the test, it is simply termed undetectable.


PSA monitoring after radical prostatectomy

PSA monitoring after radical prostatectomy is an essential way of understanding whether or not all the cancer cells have been removed. The PSA is usually checked every three months for the first one to three years and then 6 to 12 monthly thereafter. Following a radical prostatectomy, the most widely accepted definition of a recurrence is a confirmed PSA level ≥0.2 ng/mL.

If the PSA does rise above this level, the urologist may try to determine where the recurrent cancer cells are located. This may involve arranging scans such as an MRI, bone scan or CT. In cases where the PSA is very low, the clusters of prostate cancer cells might be too small to detect on any imaging tests. So sometimes pelvic radiotherapy is offered based on the probability of cancer cells being present rather than actually seeing tumour recurrence on scans. Newer molecular imaging scans, including C11-choline, F18-fluciclovine, and PSMA PET scans, can be done at select centres. These scans can more precisely identify prostate cancer metastases in the body and are significantly more sensitive than traditional bone and CT scans. All scans can, however, have difficulty in finding tumours when the PSA level is very low.

Contact Mr Neil Haldar today via his Top Doctors profile if you feel you may require PSA monitoring.

By Mr Neil Haldar

Mr Neil Haldar is a leading consultant urological surgeon based in Buckinghamshire. He sees both adult and paediatric patients. After graduating from King's College Medical School in 1992 Mr Haldar went on to join the Oxford Junior Surgical training program. From there Mr Haldar was awarded by the Royal College of Surgeons the Allinson Foundation Research Fellowship in which he was able to undertake his Master's degree at the Nuffield Department of Surgery in Oxford. Once he completed his specialty urological training, Mr Haldar became the Clinical Lead in laparoscopic urology at the Buckinghamshire NHS Trust. 

Mr Haldar is well published in most aspects of urology, with a current focus on researching Enhanced Recovery Surgery. Mr Haldar's main clinical specialties include bladder, prostate and kidney cancer. He is also an expert in minimal access surgery and in 2008 was one of the first UK surgeons to perform a single incision transperitoneal and extraperitoneal laproscopic nephrectomy. Mr Haldar also treats urinary tract infections, phimosis, circumcision, foreskin problems, hydrocoele, undecended Testes (cryptorchidism), varicocoele and herniotomy.

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