When PSA is High, Cancer’s Location Makes a Difference

You can’t judge a man’s cancer by his PSA alone. Men with PSA levels lower than 4 ng/ml can have serious disease, and men with PSA higher than 20 ng/ml can have cancer that is curable with treatment. For these men with high PSA, as in real estate, location is very important.

Some prostate cancers form in the anterior part of the prostate gland — an inaccessible area that the urologist’s finger can’t reach in a rectal examination. Other tumors — which can be felt, if they become large enough — are located in the posterior portion of the prostate. In a recent study, of men with a PSA level higher than 20 who underwent radical prostatectomy, Mark L. Gonzalgo, M.D., Ph.D., and urologists Ahmed Magheli, M.D. and Patrick C. Walsh, M.D., investigated the relationship between a tumor’s location and the likelihood that cancer will come back after surgery. The study was published in the October 2007 Journal of Urology.

“We found that tumor location was a significant factor,” says Gonzalgo, assistant professor of urology and oncology, and the Nancy and Jim O’Neal Scholar. “About 63 percent of men with anterior tumors had no evidence of PSA recurrence five years after surgery, compared to 40 percent of men with posterior tumors.” Anterior tumors were also more likely to be confined to the prostate, and less likely to involve the lymph nodes than posterior tumors.

“The good news is that regardless of tumor location, nearly half of these men with a PSA level higher than 20, treated with radical prostatectomy alone, had no evidence of PSA recurrence five years later,” Gonzalgo says. “Radical prostatectomy can benefit a large number of men with high PSA levels,” continues Gonzalgo. He adds that men who have a higher risk of having a return of cancer after surgery may benefit from additional treatments such as radiation, hormonal therapy, or chemotherapy. Gonzalgo is working with medical oncologist Mario Eisenberger, M.D., to enroll patients in a clinical trial investigating adjuvant therapy for patients with aggressive prostate cancer.



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