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.

1. 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.