PSA Testing Following Brachytherapy Treatment
Oakland, CA June 22, 2013. Dennis R. Hill M.D. Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA reports that several patients of his have questioned the value of prostate specific antigen (PSA) testing following high dose rate brachytherapy since they have read or heard about the recent change in the guidelines established by The U.S. Preventative Services Task Force (USPSTF) that shook up the status quo last July when it advised against PSA testing with average-risk men of any age who had no prostate cancer symptoms. This publication was followed this year by similar guideline from the America Urological Association (AUA) which was released last month. The AUA committee noted that the greatest benefit appears to be for those 55 to 69 but urged that men in that age group discuss the pros and cons with their doctor before deciding whether to proceed. An elevated PSA level doesn’t necessarily signify prostate cancer, but it can trigger a cascade of tests and treatments that could be riskier than the disease itself, potentially causing impotence, incontinence or even death from prostate cancer surgery.
Dr. Hill pointed out that those guidelines are addressing the use of PSA screening of normal healthy patients on a routine basis and are designed to prevent unnecessary testing and treatment. This is totally different than PSA testing of patients with established prostate cancer. After treatment for prostate cancer the most reliable method of follow-up is digital rectal exam and a PSA test. No elaborate imaging or scanning is necessary. Although the entire gland is treated with high dose rate brachytherapy, the gland is not completely ablated and some normal functioning gland remains which can continue to make some measurable PSA. It is not expected to drop to undetectable levels, rather it should drop down into a “new normal” range following treatment. For example, maybe the pretreatment PSA value was 8.4 then three months following high dose rate brachytherapy it dropped to 1.7 then at six months it was 0.7 at nine months 0.2. Over the next months and years it would vary between 1.1 and 0.1. Keeping in mind that the pretreatment PSA was 8.4 this would be an acceptable variation within the new normal range for that patient and would not raise a red flag provided the prostate exam was negative. Generally speaking, if the digital rectal exam and PSA are stable for five years or more there is very little chance that there would be a recurrence. Dr. Hill recommends PSA and digital rectal exam every three months for the first two years following treatment, then every six months out to five years, then annually after five years. Dr. Hill mentioned that on occasion there is a phenomenon called a “PSA bounce” which can occur within the first two years or more following high dose rate brachytherapy http://hdrprostatebrachytherapy.com/hdr-method/. This is a spike in a one time reading of the PSA which drops back to into the normal range on repeat testing three to six months later. Although the cause is unknown it does not raise a suspicion of recurrence. Only if there is a steady rise on three consecutive readings or a measurement of 2.0 over the lowest PSA following treatment (nadir) would Dr. Hill order other tests to rule out a recurrence.
Dr. Hill stressed that PSA testing is a vital part of the follow up program following high dose rate brachytherapy.
About Dennis R. Hill MD
Dr. Hill has been doing High Dose Rate Brachytherapy exclusively since 2004. He has done over five hundred High Dose Rate Prostate Brachytherapy implants and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD 3012 Summit Street Suite 2675 Oakland, CA 94609 510-869-8875 drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com, which includes a quiz to determine if a patient is a candidate for HDR Prostate Brachytherapy.