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Answer 1

Prostate-specific antigen, or PSA, is a protein produced by the prostate gland that can be detected in the blood, either for screening purposes (to detect cancer before it causes symptoms) or, as in your case, to monitor a person who has already been treated for prostate cancer. There are many potential causes for a elevated PSA, but in the setting of prior prostate cancer, this must be the first consideration. This is because recurrent cancer may cause PSA levels to rise well before there is any other evidence of recurrence. By 'surgery', I presume you mean that you had a radical prostatectomy, or total removal of the prostate gland. If this is the case, the expectation would be that the PSA level falls to undetectable. The significance of a rise from 0.15 to 0.28 depends on several factors, including your baseline PSA after the surgery, the rate of increase (how quickly increases are occurring, and the trend of PSA levels (e.g. is it rising steadily, or does it go up and down). Additionally, more than one level is necessary before assigning any value to an increaesed PSA (i.e. your doctor should not be basing any treatment decisions on just one measurement; I presume you've had multiple PSA levels checked over the last two years). According to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Prostate Cancer, treatment may be necessary if "their PSA level does not fall below the limits of detection after surgery or they have a detectable PSA level (> 0.3 ng/mL) that increases on two or more subsequent measurements after having no detectable PSA". Your specific PSA level is quite low, but it may be that the lab testing your blood has different cutoffs for detectable, normal etc...but the bigger question is whether your PSA is steadily increasing over time. Without knowing all the specifics of your history and bloodwork, I cannot definitively say whether or not retreatment is warranted, but it certainly seems reasonable that, in light of a steadily increasing PSA, your doctor is considering therapy.

Answer 2

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