Using the PSA test after a diagnosis of prostate cancer Gleason scale morphology involving the prostate gland with prostate cancer risk. 1. Small and uniform cells. 2 More space between cells. 3 Infiltration of non-glandular cells in the periphery. 4 masses with few irregular glandular cells. 5 No witness glandular cells. As the scale increases, the glandular cell differentiation becomes poorer. Although the PSA test is primarily used to detect prostate cancer early, also applies to other situations: After surgery or radiotherapy, the PSA level can be monitored to determine whether treatment has been successful. PSA values typically decline to very low levels if the treatment removes or destroys all prostate cells. A subsequent elevation of PSA may mean that prostate cancer cells survive and the cancer has recurred.However it is unclear what the correct treatment of patients with recurrence detected only by elevated PSA (biochemical recurrence). The way to decrease serum PSA levels depends on the chosen therapy. In patients undergoing radical prostatectomy, the PSA should drop to undetectable levels after a month or so if you have removed all the tissue. PSA levels be maintained later in this limit of detectability, as a mean elevation of tumor recurrence. If treatment is radiotherapy levels slowly decrease until it stabilized around the reference range. There may be a transient increase in PSA levels during radiotherapy, which is not a sign of disease progression. The recurrence be suspected by an increase in PSA levels. By convention states that there is biochemical recurrence after radiation therapy when detects three consecutive increases in PSA from nadir, defined as the lowest PSA value reached after radiotherapy.The PSA doubling time (more or less than 10 months, according to a previously identified cut point) is a significant factor in predicting the development of metastasis. If you are diagnosed with localized prostate cancer, PSA test can help predict the prognosis before treatment. Can be used together with the results of clinical examination (Jewett staging) and the degree of tumor differentiation (Gleason score), to help decide which diagnostic tests are needed for further evaluation (Partin Tables). From a PSA greater than 10 are recommended to perform a bone scan. Can help predict whether the cancer is confined to the prostate gland or elsewhere. If the PSA level is high, the cancer has probably exceeded the limits of the prostate.This can affect the treatment options, as some types of therapy (surgery or radiotherapy) that are not beneficial if the cancer has surpassed the lymph nodes or other organs. During hormonal therapy, the PSA level can indicate the effectiveness of treatment or when it’s time to try another type of treatment. Hormone therapy also lowers the levels of PSA reference values, this time for two reasons, firstly because this production decreases androgen dependent Second, because it decreases the tumor burden. If the cancer has surpassed the limits of the prostate (metastatic disease), then the number of PSA does not predict symptoms or survival. Many patients have very high PSA values and are asymptomatic. Other people have low values and have no symptoms. When the disease is advanced, may be more important to note the increase in PSA than the figure at the time of dissemination.

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