Prostate Specific Antigen and Local Recurrence after Radical Prostatectomy

Abstract

We evaluated the location of recurrent disease in 63 patients with carcinoma of the prostate who had abnormal levels of prostate specific antigen (greater than 0.4 ng./ml., Tandem-R assay) 6 to 240 months after radical prostatectomy but who were otherwise considered to be without evidence of disease. The evaluation involved physical examination including digital rectal examinations by 3 urologists, isotopic bone scans, computerized tomography scans of the abdomen and pelvis, cystoscopy, and random needle biopsies of the urethrovesical anastomotic area. In 6 patients metastatic disease to the bone and/or lymph nodes was found and local prostate cancer was discovered in 5. Among 57 patients without evidence of disease by the usual methods of evaluation needle biopsies of the anastomosis revealed local disease in 42%. No local disease was discovered in 30 post-radical prostatectomy patients with normal prostate specific antigen levels. There was a wide range of transrectally palpable contours after radical prostatectomy in patients with and without elevated prostate specific antigen levels. We conclude that prostate specific antigen but not digital rectal examination is an excellent early indicator of possible local recurrence after radical prostatectomy. Whether the prevalence of local disease after radical prostatectomy using prostate specific antigen levels and needle biopsies of the anastomosis is greater than heretofore has been appreciated will require further study.

Estimation of PSA Half-Life Following Salvage Radiation Therapy

“…PSA is a well-established and reliable serum biomarker for monitoring disease status in the post-radical prostatectomy setting [4] [5] [6]. After either definitive or SRT, there is a delayed response in PSA levels, because prostate cancer cell death occurs gradually over a variable and sometimes prolonged timeframe [7] [8] [9].…”

Postradical prostatectomy TRUS-guided anastomotic biopsy. Where do we stand today?

“…Main possible complication is bleeding from the anastomotic site or haematuria but occurs rarely. 25,36,38 Transrectal ultrasonography enhances the detection of biopsy-positive disease if compared to DRE alone, in cases with biochemical recurrence after radical prostatectomy where there is no evidence of distal disease.…”

“…If initial Postradical prostatectomy TRUS-guided anastomotic biopsy T Anagnostou et al biopsy fails to establish local recurrence, one repeat biopsy would successfully diagnose local cancer in another 16-17% of cases. 25,34 Some authors 36 have also evaluated cases with normal PSA levels (o0.3 ng/ml) or lower 33 than 0.5 ng/ml, and reported that no local disease was discovered. These findings support the hypothesis that presence of local recurrence in PSA range below 0.5 ng/ml seems unlikely.…”

“…DRE's accuracy was different in that aspect (finding of recurrent tumour in 30% of cases with normal DRE, but in 78% of cases with abnormal DRE). In terms of histological outcome, several studies report a variety of histological findings, while the previous mentioned studies 11,19,32,33,[36][37][38][39][40] have identified recurrent adenocarcinoma of the prostate as the only evidence of local presence of prostate tissue (Table 1).…”

A Urologist’s Personal View of Prostate Cancer

“…The evidence for local failure after radical prostatectomy has been documented with prostate bed biopsy studies showing cancer in up to 40% of PSA failure cases. [12,13] The 10-year clinical local failure rate in the SPG4 trial and the control arm of SWOG 8794 approached 20%, a rate higher than the distant failure rate. [14,15] However, studies using magnetic resonance imaging have shown a much higher incidence of bone metastatic disease than would be found by the traditional bone scan, [16] and disseminated tumor cells are present in the bone marrow in men with PSA failure with unexpected frequency.…”