High PSA with negative staging results

Last Modified: January 26, 2003

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Question

Dear OncoLink "Ask The Experts,"
My father has recently been diagnosed with PC, which includes an alarming PSA result of 168 ng/ml. Gleason score of 3+3 = 6. He was also given the "all clear" with respects to tests performed on his chest, abdomen, lungs and bones. Any further information you could provide would be greatly appreciated.  

Answer

Alan J. Wein, MD, Professor and Chair of the Division of Urology at the University of Pennsylvania School of Medicine, responds:

Ordinarily a PSA this high means that the tumor is outside of the prostatic capsule. The fact that the staging studies are negative is good news, but the most accurate study for local spread is a prostate MRI with a coil in the rectum. Rarely, one can see this level PSA with only "central gland" tumor, meaning tumor in the central part of the prostate (its usually in the peripheral part), without spread, but that is unusual at this level PSA. A level this high precludes radioactive seeds. Unless your dad is very young with a long life expectancy, one would probably choose external beam radiation over radical prostatectomy. However, one should consider a laparoscopic pelvic lymph node dissection, even though the nodes look normal on a pelvic CT scan. If the nodes were positive under the microscope, this would significantly impact the length of time hormonal therapy is recommended.