Rising or persistently elevated serum PSA following radical prostatectomy for prostate cancer: Management
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter
- Section Editor — Urologic Surgery
- Section Editor — Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Prostate specific antigen (PSA) is a sensitive and specific serum marker for prostate tissue. Serial measurements are routinely obtained to detect early disease recurrence in men who have received definitive treatment for localized disease. (See "Follow-up surveillance during and after treatment for prostate cancer".)
Following radical prostatectomy, the serum level of PSA should become undetectable since all normal prostate tissue as well as the tumor is removed. Thus, monitoring PSA after definitive treatment of localized prostate cancer leads to the identification of men with a PSA-only (biochemical) recurrence. In this situation, detection of very low levels of PSA or subsequent increases in serum PSA are not accompanied by signs or symptoms of recurrent or disseminated disease. For men in whom there is a significant likelihood that disease is confined to the prostatic bed, salvage therapy may result in prolonged disease-free survival.
The use of salvage RT for men who have a persistently elevated or rising PSA following radical prostatectomy for early stage disease will be reviewed here. Other topics relevant to patients with a rising PSA include:
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- Karnes RJ, Murphy CR, Bergstralh EJ, et al. Salvage lymph node dissection for prostate cancer nodal recurrence detected by 11C-choline positron emission tomography/computerized tomography. J Urol 2015; 193:111.
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- DEFINITION OF BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMY
- Low, persistently elevated PSA
- NATURAL HISTORY OF BIOCHEMICAL FAILURE
- SALVAGE RT
- Prognostic factors and impact on survival
- Dose of radiation
- Treatment volume
- Salvage RT versus adjuvant RT
- Salvage RT plus ADT
- ROLE OF SURGERY FOR ISOLATED PELVIC RECURRENCE
- OLIGOMETASTATIC DISEASE
- ADT ALONE
- SUMMARY AND RECOMMENDATIONS