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Recurrence of prostate cancer

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Treatment recommendations for post-prostatectomy recurrence

Following a radical prostatectomy, it is expected that serum (blood) PSA levels will be reduced to 0.2 ng/ml or less. PSA higher than 0.2 following surgery may be an indication of recurrent prostate cancer, and will necessitate re-staging the cancer, as well as a discussion of possible salvage therapies with the patient, including radiation or hormonal therapy, experimental protocols, or observation.

 

Significance and Definition of a Rising PSA post-radiation

A rising PSA following radiotherapy may indicate recurrent or residual prostate cancer. A 1996 consensus conference recommended that PSA failure be considered to have occurred after three consecutive PSA rises after completing radiation (external or seed implants).

Treatment recommendations for recurrence post-radiation

In general, rmen who have clear evidence of a rising PSA level 2 years after definitive radiotherapy for localized prostate cancer should be advised about the options of either hormonal therapy, salvage surgery, observation, or experimental therapy.

If patients have no (or controlled) additional disease, good life expectancy, and only local evidence of disease recurrence, salvage surgery is an option but should be preceded by a bone scan, CT scan, cystoscopy, and extensive counseling because urinary difficulties after salvage prostatectomy are substantial and highly prevalent.

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