Rising serum PSA following local therapy for prostate cancer: Definition, natural history, and risk stratification
- Judd W Moul, MD, FACS
Judd W Moul, MD, FACS
- James H. Semans, MD Professor of Surgery
- Division of Urologic Surgery
- Duke University Medical Center
- Director, Duke Prostate Center
- Duke Cancer Institute
- 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; Urologic Surgery; 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".)
Monitoring serum prostate specific antigen (PSA) after treatment of localized stage prostate cancer frequently leads to the identification of men with a PSA-only (biochemical) recurrence. Such recurrences generally are identified before there are signs or symptoms of either locoregional recurrence or distant metastases.
The definition of PSA-only recurrence after treatment of clinically localized prostate cancer, its natural history, and risk stratification of these patients will be reviewed here. The diagnostic evaluation and management approaches for such patients are discussed elsewhere:
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- DEFINITION OF BIOCHEMICAL PROGRESSION
- After radical prostatectomy
- - Benign PSA rise after radical prostatectomy
- After radiation therapy
- - Effect of RT on PSA
- - Phoenix criteria
- - PSA bounce
- PREDICTING BIOCHEMICAL FAILURE
- NATURAL HISTORY AFTER BIOCHEMICAL FAILURE
- Risk of metastases or death
- Specific prognostic factors
- PSA doubling time and Gleason score
- PSA "response" to ADT