Cancer and PSA levels

TO THE EDITOR: I would like to bring an issue to the attention of the community regarding the medical care I received over the past several years.

I hope by sharing my experience, it will help increase public awareness and possibly help others avoid a similar health outcome.

My prostate was removed at Vanderbilt University Medical Center in 2011 due to cancer cells in my prostate. According to the urologist who performed the surgery, it was a success.

In late 2025, I was diagnosed with metastatic (Stage 4) prostate cancer with extensive spreading to my bones and soft tissue. I was surprised by this diagnosis, especially since no issues were raised during or after my annual physical in 2024.

As a result, I requested copies of my medical records from my doctor’s office to conduct a thorough review. I also researched the standards of care for early detection of prostate cancer after a radical prostatectomy.

I discovered those standards are different than the standards for patients who still have their prostate. I also realized how important annual PSA testing is as well as the monitoring of PSA test results to identify negative trends and threshold anomalies.

PSA blood tests (Prostate-specific antigen) are done annually to check for cancer recurrence. Based upon the information included in this article, I believe some of the care I received over the past several years fell short of acceptable medical standards.

For five straight years after my surgery, my PSA level remained at 0.01 ng/mL which is the expected level after a radical prostatectomy.

In 2017, my PSA abruptly started to rise. During the seven annual physicals from 2017 to 2024, my PSA level increased significantly every time the test was performed, reaching 0.28 in 2021 and 3.54 in 2024.

The percentage increases in PSA levels from the previous test performed were: 2017, 100%; 2018, 50%; 2019, 133%; 2020, 100%; 2021, 100%; and 2024, 1,164%.

After a radical prostatectomy, the acceptable PSA range is 0.0-0.2 ng/mL, therefore, my levels in 2021 and 2024 were both highly irregular.

With age, PSA levels do increase. Therefore, some of the early increases could have been dismissed as normal.

However, with all of these factors combined, there should have been more than enough data to suspect my cancer had returned. However, my doctor failed to raise any concerns to me or mention anything regarding my lengthy negative PSA trend or the two high PSA levels, and to make matters worse, my nurse practitioner failed to order a PSA test during my 2022 annual physical.

This was an important PSA test during a very crucial time. Annual screening PSA tests are fully covered by Medicare, and this simple blood test should have been ordered, especially considering my prior prostate cancer.

Every cancer publication and cancer center website I reviewed discusses what normal PSA levels should be after a radical prostatectomy and the importance of taking action if PSA levels begin to rise especially above certain thresholds. Excerpts from several of those websites are shown below.

— John’s Hopkins Medicine — “The Role of PSA” “Prostate cancer recurrence is determined by rising PSA levels following treatment.” “After surgery, PSA levels should drop to zero. When PSA levels rise above 0.2 ng/mL, the cancer is considered recurrent.”

— Harvard Health Publishing — “PSA should be undetectable in blood if the prostate has been removed, so elevated levels signify that the cancer may have returned.” “The time-honored normal PSA range of 0 to 4 ng/mL no longer applies when men have had their prostates surgically removed.”

— Mayo Clinic — “Most people with a cancer recurrence don’t experience any symptoms, but their prostate-specific antigen (PSA) levels begin to rise.” “After prostate- removal surgery — called a radical prostatectomy — PSA is expected to fall to very low or undetectable levels. In most cases, PSA should remain below 0.1 ng/mL. A confirmed PSA rise to 0.2 ng/mL or higher is the standard definition of what is called biochemical recurrence.”

— Prostate Cancer Foundation – “When to be concerned about rising PSA: Surgery Patients: PSA greater than 0.2 ng/mL. Some doctors may have a lower threshold of concern (as low as 0.1 ng/mL).”

— National Institutes of Health — National Library of Medicine – “The screening threshold of 4.0 ng/mL is not relevant in the post prostatectomy setting where 0.2 ng/mL is considered treatment failure, warranting salvage-treatment discussions.”

I believe my diagnosis and subsequent treatment was significantly delayed based on the information provided above.

I am currently dealing with the major side effects of cancer treatment and a decrease in my life expectancy since my cancer is incurable. Even though the facts of my case are unique to me, it should be a reminder to all patients how important it is to be more “educated” and “involved” in your healthcare.

We all need to constantly remind ourselves how important our health is, to be proactive when medical issues arise and to not postpone your medical care.