ORLANDO--Today, after more than 10 years of research, PSA-related
testing can daunt even the most experienced urologists, said a
panel of experts at the American Urological Association meeting.
Three panelists advised urologists on how to interpret a rising
PSA after prostate cancer treatment and what further actions to
take when this occurs.
Patrick C. Walsh, MD, of Johns Hopkins University School of Medicine,
advised that in patients who have had a radical prostatectomy,
"any PSA that is measurable should be considered elevated."
But, he cautioned, "be certain the result came from a lab
you can trust, or else repeat it." Dr. Walsh also told the
audience to consider any induration on rectal examination as a
For patients with an elevated PSA after surgery, for whom distant
metastases are suspected, the work-up should include a pelvic
CT scan, bone scan, and chest x-ray. Thereafter, Dr. Walsh recommends
annual bone scans.
Timing of PSA recurrence is also instructive. "If it occurs
within a year, or the Gleason score is 8 to 10, or positive seminal
vesicles or positive lymph nodes are found, most likely that patient
will fail from distant metastases," he said. Alternatively,
PSA recurrence more than a year out, or with a Gleason score 2
to 7, or negative nodes and negative seminal vesicles, is possibly
a local recurrence.
After Radiotherapy or Cryosurgery
Evaluating a rising PSA after radiotherapy or cryosurgery poses
other challenges. "A good guideline is to begin measuring
PSA 3 months after radiotherapy," said Peter C. Scardino,
of Baylor College of Medicine, Houston. He cautioned that earlier
testing may be misleading.
"The most important prognostic factor in radiotherapy-treated
patients is pretreatment PSA, with a rising PSA after treatment
well accepted as an indication of recurrent cancer," he said.