What if PSA Goes Up After Surgery?
At 10 years, 70% of the patients who underwent an anatomical approach
to radical prostatectomy at The Johns Hopkins Hospital have an
undetectable serum PSA. What about the rest of the patients and
what does an elevated serum PSA mean following surgery?
Because PSA is prostate specific, it means that some prostate cells
must be present. Although it is possible in rare instances that
some benign prostate cells may be responsible for the elevated serum
PSA, it usually means that some residual cancer cells are present.
But where are they and what do they mean? We recently evaluated 51
men who had an elevated serum PSA following radical prostatectomy.
These patients were followed expectantly until the source for the PSA
elevation was detected: in 30% the disease recurred locally and in
70% the cancer recurred in lymph nodes or in bone. We determined
that if the PSA elevation occurred during the first postoperative
year, or if the patient had involvement of his seminal vesicles or
lymph nodes, or if the patient had high-grade disease (Gleason 8-10)
the cancer almost always recurred through distant mctastases.
Using information from this study we have created a nomogram which
enables us to identify those patients who are most likely to have
local recurrences of cancer that may benefit from radiation therapy
to the prostatic bed.
- Partin, A.W., Pearson, J.D., Landis, P.K., Carter,
H.B., Pound, C.R., Clemens, J.Q, Epstein, J., and Walsh, P.C.:
Evaluation of serum prostatic specific antigen velocity after radical
prostatectomy to distinguish local recurrence versus distant
metastases. Urology: in press, 1994.