What you should know about PSA levels after treatment for prostate cancer

PSA, or prostate-specific antigen, is a protein made by normal and malignant cells in the prostate.

Biochemical recurrence is the idea that after prostate cancer is treated, some cancer cells survive and can cause increases in PSA.

This elevation in PSA can indicate that the cancer has either not gone away completely or has reappeared – even though the patient is not showing any symptoms.

“In other words, a patient’s blood PSA level was found to indicate a return of his prostate cancer, but on imaging and scans, there is no evidence of any cancer anywhere in the body — this generally happens when the amount of cancer is small,” he said. too much for our current imaging to detect.” Dr. Roshi Talwar, a fellow in urological oncology at Vanderbilt University Medical Center in Nashville, Tennessee. Talwar was not part of the study.

The UCLA research team analyzed data from 11 trials involving 10,741 patients. The researchers looked at biochemical recurrence in prostate cancer patients to understand if there was an association between recurrence, treatment of recurrence, and overall survival.

While recurrence, in theory, appears to be a promising marker for understanding whether cancer has come back, there is no evidence to show that this is useful in predicting overall survival for patients with prostate cancer.

The study authors note that biochemical replication should not be considered the primary end point when establishing treatments for prostate cancer.

Instead, when treatments are established, “metastasis-free survival remains an appropriate endpoint for potential trials of radiotherapy in localized disease,” according to the study.

“PSA blood tests are one of the tools doctors can use to detect prostate cancer,” Talwar explains.

PSA is a protein produced by the prostate gland. Even in a healthy prostate, the PSA level can be detected. However, in cases where the PSA level is elevated, it causes doctors to worry that there may be cancer or the possibility of proliferating cells within the prostate.

If someone is diagnosed with prostate cancer, some men will undergo radiation or even surgery to treat the condition.

He said, “PSA (as a biomarker of response to treatment) is actually incredibly useful and is one of the best markers in oncology – especially since all recurrences have been associated with a rise in PSA.” Dr. Ammar Kishanassociate professor of radiation oncology at UCLA David Geffen School of Medicine, and senior author of the study.

Traditionally, after treatment for prostate cancer, PSA levels drop dramatically to undetectable levels.

“After treatment, PSA blood tests are used to monitor prostate cancer (recurrence) which means active cancer has returned after treatment, and in some specific cases, PSA blood (tests) are used to determine if additional treatment is needed, such as radiation,” Talwar explained. Healthline takes treatment soon after surgery.

In the routine follow-up, the next step will be to undergo imaging studies. However, this is not always visible on imaging and a rise in PSA can be one of the first signs of recurrence.

Two primary treatments used after repeat biochemistry are salvage radiotherapy and androgen deprivation therapy.

Salvage radiotherapy is a treatment aimed at local control to prevent and delay metastases through radiotherapy.

Androgen deprivation therapy or hormonal injections may be used to lower the PSA level.

but. It is known whether these shots help people live longer. In addition, they can cause side effects such as bone thinning and even increased risk of diabetes.

“PSA monitoring can be an important tool,” Talwar explains, “but it’s certainly not perfect.” She advises and recommends more research in this area to help further understand how it is used.

Kishan points out that not all recurrences of the disease are fatal.

He says using the information from his study can help not only design clinical trials, but also understand endpoints and what that might mean for survival.

Many of the studies surrounding biochemical recurrence correlate with viability. However, quality of life is another measure that should be examined, but most studies did not look at this endpoint.

A new study by a UCLA research team has found that using frequency PSA levels to determine overall survival may not be the best predictor of feeling better or living longer.

Dr. Rajeev Bahl, MBA, MSc, is an emergency medicine physician, board member of the Florida College of Emergency Physicians, and health writer. You can find it at RajivBahlMD.