A rise in your PSA may be the first sign that your cancer has come back. If you have any of the symptoms, let your doctor or nurse know. These can be a sign that the cancer has come back – but they are often a side effect of treatment, or caused by something else which has nothing to do with your cancer, such as an enlarged prostate.
The exact change in PSA level that suggests your cancer has come back depends on which treatment you had. Speak to your doctor or nurse about your own situation.
PSA level after surgery
After surgery, your PSA level should drop to an undetectable level, usually less than 0.1ng/ml. This is because the prostate gland, which produces PSA, has been removed. If your cancer has returned, there would be a measurable amount of PSA which rises over time.
Some hospitals use ‘super sensitive’ PSA testing, which can measure PSA levels as low as 0.01ng/ml or 0.02ng/ml. This may be able to detect signs that the cancer has come back at a very early stage. If a hospital uses super sensitive PSA testing, they will have their own guidelines of what an undetectable PSA level is. This is a fairly new way of measuring PSA, and it is not available in all hospitals.
PSA level after radiotherapy or brachytherapy
After radiotherapy or brachytherapy, your PSA should drop to its lowest level (nadir) after 18 months to two years. Some PSA will still show up in tests because healthy prostate tissue will continue to produce it. Sometimes men may have a rise and fall in PSA around one to two years after treatment. This is called ‘PSA bounce’. It is normal, and doesn’t show that the cancer has come back. A sign that your cancer may have returned is if your PSA level has risen by 2ng/ml or more above its lowest level, or if it has risen for three or four PSA tests in a row.
If you had hormone therapy before radiotherapy or brachytherapy, your PSA level should drop to a lower level quite quickly. If you continue to have hormone therapy after radiotherapy, your PSA level may continue to fall further. There may be a small rise in PSA after you finish the hormone therapy. This is normal and does not mean that your cancer has come back. However, a rise of more than 2ng/ml from your lowest level may suggest that your cancer has come back. But even if your PSA does rise this much, your doctor may want to know how quickly (or slowly) it is rising. In this case you may have your PSA monitored for at least six months before deciding on a treatment.
PSA level after HIFU or cryotherapy
Because these treatments are relatively new, we don’t know so much about what level of PSA might indicate that your cancer has come back. Speak to your doctor or nurse about your own situation.
If your cancer does come back, there are other treatments you can have which aim to control or get rid of it. Speak to your doctor or nurse about your options.