PSA after prostatectomy or radiation treatments

Following radical prostatectomy surgery, the PSA should be undetectable.

After radiation, there are often residual normal prostate cells that still make some PSA. 

PSA monitoring after treatment is an important way of understanding whether or not all the prostate cancer cells have been destroyed.

PSA is produced by all prostate cells, not just prostate cancer cells. 

To determine site of recurrence imaging, such as a CT, MRI, or bone scan. 

Where PSA is still very low, imaging tests may not provide enough information to determine a further course of action. 

Newer molecular imaging scans can be done at select centers; these scans include C11-choline, F18-and F18-sodium fluoride.

PSMA-PET uses PSMA to more precisely identify prostate cancer metastases. 

It is significantly more sensitive than traditional bone and CT scans.

After the surgical removal of the prostate (prostatectomy) PSA drops to virtually undetectable levels (less than 0.1), which is effectively zero.

After radiation therapy, the PSA level rarely drops to zero: healthy prostate tissue isn’t always completely killed during radiation therapy. 

The low point, or nadir, becomes the benchmark by which to measure a rise in PSA.

Following a prostatectomy, the most widely accepted definition of a recurrence is a confirmed PSA level of 0.2 ng/mL or higher. 

After radiation therapy, the most widely accepted definition is a PSA that rises from the nadir by 2.0 ng/mL or more. 

After radiation therapy, the PSA can Jump up for a short period, and will later return to its low level. 

PSA bounces typically occur between 12 months and 2 years following the end of initial therapy.

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