- With Mayo Clinic urologist
Erik Castle, M.D.
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Erik Castle, M.D.
Erik Castle, M.D.
Dr. Erik Castle is a board-certified urologist who joined the Mayo Clinic staff in Arizona in 2007.
Dr. Castle is an associate professor of urology at College of Medicine, Mayo Clinic, and a senior associate consultant in the Department of Urology, where he also is assistant residency coordinator.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancer.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is president of the international Society of Urologic Robotic Surgeons. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
Risk factors (2)
- Flaxseed: Does it affect risk of prostate cancer?
- Vasectomy: Does it increase my risk of prostate cancer?
Tests and diagnosis (2)
- Prostate cancer: Does PSA level affect prognosis?
- Watchful waiting and prostate cancer: What does it mean?
Complications (1)
- Prostate cancer: Can it spread to the pancreas?
Treatments and drugs (3)
- Prostate cancer brachytherapy: Can I pass radiation to others?
- Prostate cancer treatment: Is prostatectomy possible if brachytherapy fails?
- Ginger for chemotherapy-induced nausea: Does it work?
Alternative medicine (1)
- Pomegranate juice: A cure for prostate cancer?
Prevention (2)
- Prostate cancer vaccine: Is it available?
- Frequent sex: Does it protect against prostate cancer?
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Question
Prostate cancer: Does PSA level affect prognosis?
I read that prostate cancer may grow slowly because PSA keeps it in check. So, men with higher PSA levels have a better prognosis for prostate cancer than do men with lower PSA levels. Is this true?
Answer
from Erik Castle, M.D.
In most cases, a higher PSA level does not mean a better prognosis and actually the opposite is true. PSA does not keep prostate cancer "in check," but rather is a measure of the cancer. Only in rare cases where a mutated and aggressive cancer occurs are low or normal PSA levels found.
Prostate-specific antigen (PSA) is a protein made by prostate tissue. Men with prostate cancer often have elevated PSA levels because the cancer cells make excessive amounts of this protein.
At the time of initial diagnosis of prostate cancer, PSA level helps determine how likely it is that the cancer has spread (metastasized). It also helps determine how likely the cancer will be cured with treatment such as radiation or surgery. Generally, the higher your PSA level and the higher the rate at which it increases, the more prostate cancer cells you have in your body.
But this isn't always true. In some cases, the PSA level may not be elevated, despite the presence of prostate cancer. In such cases, the cancer cells often have more genetic mutations than other prostate cancer cells do, and they don't have the ability to make PSA. This type of prostate cancer is usually more aggressive and doesn't respond well to treatment. Some scientists believe that genetic mutations in these cancer cells may allow such cancers to grow and spread more quickly.
Prostate cancer often grows very slowly. The reasons for this aren't clear. Some research suggests that PSA may inhibit the formation of new blood vessels (angiogenesis) that contribute to the growth of cancer. Still, you shouldn't interpret a high PSA level to be protective against prostate cancer or how quickly it spreads. Discuss the results of your PSA test with your doctor.
Next questionWatchful waiting and prostate cancer: What does it mean?
- Leibovici D, et al. Prostate cancer progression in the presence of undetectable or low serum prostate-specific antigen. Cancer. 2007;109:198.
- Meeks JJ, et al. Characteristics of prostate cancers detected at prostate specific antigen levels less than 2.5 ng/ml. The Journal of Urology. 2009;181:2515.
- Lilja H, et al. Prostate-specific antigen and prostate cancer: Prediction, detection and monitoring. Nature Reviews/Cancer. 2008;8:268.
- Ahyai SA, et al. Contemporary prostate cancer prevalence among T1c biopsy-referred men with prostate-specific antigen level < or = 4.0ng per milliliter. European Urology. 2008;53:750.
- Fall K, et al. Prostate-specific antigen levels as a predictor of lethal prostate cancer. Journal of the National Cancer Institute. 2007;99:256.
