PSA helps track patient after excision

Tue., June 29, 2004

Peter Gott United Media

Dear Dr. Gott: My husband had prostate cancer, forcing him to have his prostate gland (and nearby lymph nodes) removed. Now his urologist wants to have a PSA test done periodically. Although I understand that the PSA is a valuable tool in discovering prostate cancer, I question whether this test is appropriate for a man whose prostate gland has been removed. Is this test appropriate for my husband, and if so, why? Dear reader: You are correct that the prostate specific antigen (PSA) is a valuable method of detecting the presence of hidden prostate cancer. It is also an appropriate technique to follow patients who have required prostate excision. Here’s why. The normal PSA should not exceed 4 nanograms per milliliter. However, in men following prostate removal, it should be too low to measure (less than 1), unless the cancer has spread and is undetected. Therefore, your husband’s urologist is correct. If your husband’s PSA rises from an extremely low value — even if the rise is way below the limit of 4 — this could indicate the presence of prostate cancer elsewhere in the body because, as you concluded, his prostate gland has been removed and will not grow back. In this situation, a rising PSA must reflect prostatic tissue in sites other than the gland itself; in short, metastatic prostate cancer. I encourage your husband to follow his doctor’s advice about further, periodic testing. And, by all means, ask the urologist to clarify any issues or concerns that you may have. To give you related information, I am sending you a copy of my Health Report “The Prostate Gland.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title. Dear Dr. Gott: I’m 71 and had a colonoscopy last year. Is it necessary to have this exam annually? Dear reader: No it isn’t. Ordinarily, colonoscopic exams should be started in both men and women at about 50 years of age. If nothing abnormal is discovered, the exam need not be repeated for 10 years. If the specialist discovers benign polyps, the patient should have a repeat exam in about five years. Should a colonoscopic exam reveal pre-malignant polyps (or if there is a family history of colon cancer), the patient should have a repeat study at the discretion of the physician — usually in two or three years. You do not require annual colonoscopies, but follow the instructions of the specialist.

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