Dr. Barry W. Goy

Dr. Barry W. Goy explains how to interpret PSA levels after prostate cancer treatment and how to manage recurrence based on disease progression.

Understanding How One Must Interpret PSA Levels in Prostate Cancer

Among patients with intermediate-risk prostate cancer, treatment with external-beam radiation therapy (EBRT) with or without six months of neoadjuvant-deprivation-therapy (NADT) showed a high prostate-cancer-specific-survival of 91%, according to research shares in a poster at the 

2025 ASCO Genitourinary Cancers Symposium.

In a comparison of NADT plus EBRT versus EBRT alone, 15-year freedom-from-biochemical-failure; metastases-free survival; prostate-cancer-specific survival; and overall survival were 52% versus 49%; 85% versus 83%; 91% versus 91%; and 53% versus 51%, respectively.

CURE spoke with lead study author and presenter Dr. Barry W. Goy to discuss how to interpret rising prostate-specific antigen (PSA) levels after treatment, and what steps patients can take to manage their disease effectively.

Prostate-specific antigen (PSA): a protein produced by the prostate gland, often used as a biomarker for prostate cancer detection and monitoring.

External-beam radiation therapy (EBRT): a form of radiation therapy that delivers high-energy beams to a tumor from outside the body.

Neoadjuvant-deprivation therapy (NADT): hormonal therapy given before primary cancer treatment to reduce tumor size or slow growth.

Freedom-from-biochemical-failure: the absence of rising tumor markers, such as PSA in prostate cancer, after treatment.

Metastases-free survival: the time from treatment to the development of distant cancer spread or death.

Prostate-cancer-specific survival: the time from treatment to death specifically due to prostate cancer.

Overall survival: the time from treatment to death from any cause.

Goy is a physician of Radiation Oncology at Kaiser Permanente, Los Angeles Medical Center, in California.

Most patients will rely on their physicians, and of course, it varies in terms of how PSA failures are approached from one physician to another. At our institution, our initial approach is to find out where the cancer is. We have a PSA-PET scan, which is more accurate these days, but still in the context, the death rate of prostate cancer in this group of patients is still quite low. One has to be able to assess how long these patients are going to live.

If you look at our experience and many others, most patients tend not to die of prostate cancer. Whenever we recommend something, we have to look at what side effects are we causing for them. We usually try to work up where the cancer is. Sometimes, if it's not metastatic by imaging, we'll do a prostate biopsy, and we'll consider salvaged local therapy like cryotherapy or HIFU if the patient has enough longevity. Certainly, if the patient's not going to be around that long, it may be just wise to watch it if the recurrence is indolent. If there are patients where the cancer recurs more quicker or the PSA doubling time is more rapid, like less than a year, and you see visible evidence of metastasis, then it may be worthwhile to put patients on salvage ADT. For many patients that can last them for the rest of their lives.

Transcript has been edited for clarity and conciseness.

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Dr. Barry W. Goy

Understanding How One Must Interpret PSA Levels in Prostate Cancer

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