My then 45yo spouse had a radical prostatectomy with nerve sparing done at UCLA MC June 1999. His Gleason score was on the high side and his reg PSA was in the low 20s pre-op. After consulting with multiple UROs, Radiation Onc etc, everyone recommended surgery so the final decision to proceed with surgical intervention was easy. The surgeon told us the cancer had made it to the edge of the prostate organ itself but had not gone beyond it. Margins were clear and no evidence found anywhere else othat it had spread.
Given the rapidity of the PSA rise prior to the surgery and the extremely limited life expectancy outcome data I found back in 1999 for men age 45 and under having prostate cancer, I am personally convinced prostate cancer is much more aggressive when diagnosed at a younger age. Watchful waiting isn't a realistic option.
Care needs to be taken in choosing what to do as a first response-once the horse is out of the barn, it can't be put back in the barn. There is a need to leave room for possible future need for treatment not already tried initially. For example, if you opt for Radiation as the first response, additional Radiation down the road isn't an option etc.
He had regular PSA testing done post op from 1999 through 2007 and all were 0 or less than 0.
A new Internist told us about the Hypersensitive PSA lab test in 2008 that apparently is only processed by Dianon Lab in CT. He had that done and it too showed a virtually undetectable level.
He had his 2009 Hypersensitive PSA done mid Feb. 2009 and it came back at 2.8
It has been re-drawn and we await the results to rule out any Lab error.
Our Internist tells us one can only have a PSA value if there are prostate cells floating around. A PSA value is not caused by any other source. Just because he no longer has a prostate doesn't mean a few errant cells did not "escape" prior to or at surgery and have been circulating under the radar all these years.
He is 4 mos shy of being 10yrs out from his 1999 surgery. He did not have any treatment for the prostate cancer other than the surgery. No trouble at all with incontinence and only minor ED issues. Recovery time was uncomplicated and he was only off work for 4 wks. Exercises, eats well, is a believer in soy and has an overall healthy weight and life style.
The Hypersensitive PSA is a double edge sword. I don't know that a reg PSA blood test would have reflected this current finding. His values were fine for 9 1/2 yrs before this happened. The real kicker will be what to do if the repeat Hypersensitive PSA value remains elevated. He will be 55 later this year. He's not done with work or life by a long shot.
Remain vigilant and don't ever think that when you reach the 5yr or 10yr mark post surgery that you will be permanently cured. There's a reason why PSA lab testing for men who have ever had prostate cancer will be a lifelong requirement. In my husband's case, it identified he had prostate cancer in the first place and now it might mean that despite the 9 1/2 yr time lag he may have to contend with the orig prostate cancer having spread without being any the wiser... until now.
Stay safe and don't let your guard down. Comply with having PSA levels done as directed by your Uro and/or regular primary MD. If they don't order it, you make sure you say you have to have it done.