PSA of 0.1 18 months after robotic prostatectomy

A prostate-specific antigen (PSA) level of 0.1 ng/mL measured 18 months after robotic prostatectomy is a very low value. The clinical significance of this level primarily depends on the trend of serial PSA measurements, as biochemical relapse after radical treatment is defined by a rising PSA NICE NG131.

Key considerations for this PSA level include:

• Follow-up Schedule: After radical treatment, PSA levels should be checked no earlier than 6 weeks post-treatment, at least every 6 months for the first 2 years, and then at least once a year thereafter NICE NG131. A measurement at 18 months aligns with this recommended schedule.


• Biochemical Relapse: Biochemical relapse is indicated by a rising PSA after radical treatment NICE NG131. While 0.1 ng/mL is low, it is crucial to compare it with previous PSA values, especially the nadir (lowest point) achieved after surgery. If this represents a rise from an undetectable level, it could signify biochemical relapse.


• Analysis of Serial Levels: Serial PSA levels after radical treatment should be analysed using the same assay technique NICE NG131.


• Management of Biochemical Relapse: If a rising PSA indicates biochemical relapse:
  
  
  
  • A rising PSA alone should not necessitate an immediate change in treatment NICE NG131.
  
  
  • Estimate the PSA doubling time, based on a minimum of 3 measurements over at least a 6-month period NICE NG131.
  
  
  • For people with biochemical relapse after radical prostatectomy and no known metastases, radical radiotherapy to the prostatic bed should be offered NICE NG131.
  
  
  • An isotope bone scan should be offered if symptoms or PSA trends suggest metastases NICE NG131.
  
  
  • Biopsy of the prostatic bed should not be offered NICE NG131.
  
  
  • Hormonal therapy should not be routinely offered unless there is symptomatic local disease progression, any proven metastases, or a PSA doubling time of less than 3 months NICE NG131.
  
  
  • Consider entry into appropriate clinical trials NICE NG131.