Rising serum PSA following local therapy for prostate cancer: Diagnostic evaluation
- 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.
Monitoring serum PSA after treatment of localized 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. (See "Follow-up surveillance during and after treatment for prostate cancer".)
The rationale and role of diagnostic studies in patients with a rising serum PSA after definitive treatment for prostate cancer is discussed here. Other related topics include:
- Koo PJ, Crawford ED. (18)F-NaF PET/CT and (11)C-Choline PET/CT for the initial detection of metastatic disease in prostate cancer: Overview and potential utilization. Oncology (Williston Park) 2014; 28:1057.
- Cher ML, Bianco FJ Jr, Lam JS, et al. Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy. J Urol 1998; 160:1387.
- Kane CJ, Amling CL, Johnstone PA, et al. Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy. Urology 2003; 61:607.
- Dotan ZA, Bianco FJ Jr, Rabbani F, et al. Pattern of prostate-specific antigen (PSA) failure dictates the probability of a positive bone scan in patients with an increasing PSA after radical prostatectomy. J Clin Oncol 2005; 23:1962.
- Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-fluoride PET in patients with known prostate cancer: initial results from the National Oncologic PET Registry. J Nucl Med 2014; 55:574.
- von Eyben FE, Kairemo K. Acquisition with (11)C-choline and (18)F-fluorocholine PET/CT for patients with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Ann Nucl Med 2016; 30:385.
- Krämer S, Görich J, Gottfried HW, et al. Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy. Br J Radiol 1997; 70:995.
- Silverman JM, Krebs TL. MR imaging evaluation with a transrectal surface coil of local recurrence of prostatic cancer in men who have undergone radical prostatectomy. AJR Am J Roentgenol 1997; 168:379.
- Sala E, Eberhardt SC, Akin O, et al. Endorectal MR imaging before salvage prostatectomy: tumor localization and staging. Radiology 2006; 238:176.
- Huch Böni RA, Meyenberger C, Pok Lundquist J, et al. Value of endorectal coil versus body coil MRI for diagnosis of recurrent pelvic malignancies. Abdom Imaging 1996; 21:345.
- Sella T, Schwartz LH, Swindle PW, et al. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 2004; 231:379.
- Kitajima K, Murphy RC, Nathan MA, Sugimura K. Update on positron emission tomography for imaging of prostate cancer. Int J Urol 2014; 21:12.
- Hofer C, Laubenbacher C, Block T, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for the detection of local recurrence after radical prostatectomy. Eur Urol 1999; 36:31.
- Seltzer MA, Barbaric Z, Belldegrun A, et al. Comparison of helical computerized tomography, positron emission tomography and monoclonal antibody scans for evaluation of lymph node metastases in patients with prostate specific antigen relapse after treatment for localized prostate cancer. J Urol 1999; 162:1322.
- Turlakow A, Larson SM, Coakley F, et al. Local detection of prostate cancer by positron emission tomography with 2-fluorodeoxyglucose: comparison of filtered back projection and iterative reconstruction with segmented attenuation correction. Q J Nucl Med 2001; 45:235.
- Nuñez R, Macapinlac HA, Yeung HW, et al. Combined 18F-FDG and 11C-methionine PET scans in patients with newly progressive metastatic prostate cancer. J Nucl Med 2002; 43:46.
- Morris MJ, Akhurst T, Osman I, et al. Fluorinated deoxyglucose positron emission tomography imaging in progressive metastatic prostate cancer. Urology 2002; 59:913.
- Sanz G, Robles JE, Giménez M, et al. Positron emission tomography with 18fluorine-labelled deoxyglucose: utility in localized and advanced prostate cancer. BJU Int 1999; 84:1028.
- DeGrado TR, Coleman RE, Wang S, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res 2001; 61:110.
- Cimitan M, Bortolus R, Morassut S, et al. [18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging 2006; 33:1387.
- Oyama N, Miller TR, Dehdashti F, et al. 11C-acetate PET imaging of prostate cancer: detection of recurrent disease at PSA relapse. J Nucl Med 2003; 44:549.
- Wachter S, Tomek S, Kurtaran A, et al. 11C-acetate positron emission tomography imaging and image fusion with computed tomography and magnetic resonance imaging in patients with recurrent prostate cancer. J Clin Oncol 2006; 24:2513.
- Albrecht S, Buchegger F, Soloviev D, et al. (11)C-acetate PET in the early evaluation of prostate cancer recurrence. Eur J Nucl Med Mol Imaging 2007; 34:185.
- Sandblom G, Sörensen J, Lundin N, et al. Positron emission tomography with C11-acetate for tumor detection and localization in patients with prostate-specific antigen relapse after radical prostatectomy. Urology 2006; 67:996.
- http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/208054s000lbl.pdf (Accessed on December 13, 2016).
- Bach-Gansmo T, Nanni C, Nieh PT, et al. Multisite Experience of the Safety, Detection Rate and Diagnostic Performance of Fluciclovine ((18)F) Positron Emission Tomography/Computerized Tomography Imaging in the Staging of Biochemically Recurrent Prostate Cancer. J Urol 2017; 197:676.
- Zagars GK, Pollack A, von Eschenbach AC. Prostate cancer and radiation therapy--the message conveyed by serum prostate-specific antigen. Int J Radiat Oncol Biol Phys 1995; 33:23.
- Foster LS, Jajodia P, Fournier G Jr, et al. The value of prostate specific antigen and transrectal ultrasound guided biopsy in detecting prostatic fossa recurrences following radical prostatectomy. J Urol 1993; 149:1024.
- Shekarriz B, Upadhyay J, Wood DP Jr, et al. Vesicourethral anastomosis biopsy after radical prostatectomy: predictive value of prostate-specific antigen and pathologic stage. Urology 1999; 54:1044.
- Kabalin JN, Hodge KK, McNeal JE, et al. Identification of residual cancer in the prostate following radiation therapy: role of transrectal ultrasound guided biopsy and prostate specific antigen. J Urol 1989; 142:326.
- Cox JD, Gallagher MJ, Hammond EH, et al. Consensus statements on radiation therapy of prostate cancer: guidelines for prostate re-biopsy after radiation and for radiation therapy with rising prostate-specific antigen levels after radical prostatectomy. American Society for Therapeutic Radiology and Oncology Consensus Panel. J Clin Oncol 1999; 17:1155.
- Connolly JA, Shinohara K, Presti JC Jr, Carroll PR. Local recurrence after radical prostatectomy: characteristics in size, location, and relationship to prostate-specific antigen and surgical margins. Urology 1996; 47:225.
- Fowler JE Jr, Brooks J, Pandey P, Seaver LE. Variable histology of anastomotic biopsies with detectable prostate specific antigen after radical prostatectomy. J Urol 1995; 153:1011.
- Leventis AK, Shariat SF, Slawin KM. Local recurrence after radical prostatectomy: correlation of US features with prostatic fossa biopsy findings. Radiology 2001; 219:432.