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 local recurrence.
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.