BY MARK SCHOLZ, MD Only 5-15% of men describe their sexual function as “undiminished” after prostate cancer surgery. And I’ll venture that 0% describe it as improved. If you accept any degree …
Over 60,000 men relapse after surgery or radiation each year. With other types of cancer, colon or lung for example, relapse is detected when a scan shows metastases. Prostate cancer is different. Relapse can be detected by the PSA blood test when the cancer is still microscopic. With prostate cancer, scan-detected metastases may take ten or more years to appear after a PSA relapse occurs. In the context of the broader cancer world, therefore, a “PSA relapse,” represents a “twilight zone” between two extreme situations— men who are still in remission and men with overt, scan-detected metastasis.
There are exceptions to the generally reliable rule that PSA is always detectable when cancer is present. These exceptions occur when, 1) There is a positive margin present after surgery and, 2) When there is a positive biopsy after radiation. In the former case, the amount of persistent disease after surgery is too tiny to be detected by PSA. In the latter case, PSA production originating from the residual prostate gland “overshadows” the PSA coming from cancer. Therefore, as a result, without biopsy, detection of relapse after radiation is generally delayed until the PSA rises above the 1 to 2.