Diagnosis

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

How should my recurrent disease be evaluated? 

Question: My PSA is rising with a doubling time of 12 months. It began rising 2 years after my radical prostatectomy. My last PSA was 0.85 nanograms per milliliter and I had a biopsy taken on my prostatic fossa (cavity). It was negative. What is the next step to evaluate my disease?

Answer: An extent-of-disease work-up—including a CT scan of your abdomen and pelvis—chest x-ray and bone scan should be done as baseline. I would expect these tests to be negative for metastatic disease. A ProstaScint scan may show that the disease is localized to the prostatic fossa.

Do I need a prostate biopsy? 

Question: My PSA is rising with a doubling time of 12 months. It began rising 2 years after my radical prostatectomy. My last PSA was 0.85 nanograms per milliliter and I my urologist recommended a prostatic fossa biopsy. What are the chances of the biopsy being useful?

Answer: A prostatic biopsy will only be positive at 50 percent or less of the time, so it is not routinely recommended.

What PSA indicates radical prostatectomy failure? 

Question: What is the PSA level that is considered to be indicative of failure after a radical prostatectomy?

Answer: Although most doctors believe 0.2 nanograms per milliliter indicates a radical prostatectomy failure, some believe a 0.4 level indicates failure.

Is PSA a good indicator of response to therapy? 

Question: I have been on a clinical trial with a new chemotherapeutic agent. My doctors take frequent PSA readings as well as scans. My PSA is going down and my scans are unchanged. Does this mean I am responding to my treatments?

Answer: In most studies it does tend to correlate with response and improvement in disease-free survival and frequently overall survival. There are always, however, exceptions to this rule. It seems that a 30 percent decline 3 months after initiation of chemotherapy is most prognostic for survival in patients treated with chemotherapy.

What is the best way to get the correct answers to questions when you have newly diagnosed prostate cancer? 

Question: I am a 59-year-old white male who had a PSA that was 6.5, up from 3.0 a year ago. My digital rectal examination was abnormal. The urologist felt a nodule on the right side of my prostate. Three out of 10 cores showed a Gleason 3 + 3 = 6 adenocarcinoma with perineural (surrounding a nerve) involvement. What should I do next?

Answer: You have probably heard the recommendations of your urologist. I would get an opinion from a radiation oncologist and a medical oncologist so that you are aware of all the treatments available and how they will affect your quality of life. Unfortunately, there are no mature randomized controlled trials to dictate one treatment over another.

How accurate are bone scans to determine if a patient is responding to treatment? 

Question: I am a 62 year old who has bone metastases and a falling PSA after 5 months on hormonal therapy. Does a bone scan help tell if I'm responding to my treatments?

Answer: Unfortunately, bone scans are a rather crude way of measuring response to treatment because bone conditions change very slowly and the scans can be misleading. The "hotter areas" may be misinterpreted as worse, when in fact, there is an increase in bone healing. Careful correlation of the bone scan results with the patient's symptoms, PSA data, and comparison with previous scans and x-rays are needed.

Is anemia associated with prognosis in patients with metastatic prostate cancer? 

Question: My friend was diagnosed with prostate cancer and bony involvement. He was told that his bone marrow was involved and as a result he was anemic. Will this affect his survival time?

Answer: Overall, yes. The lower the hemoglobin and hematocrit (red blood cell levels), the less the overall survival time in general.