A Publication of the James Buchanan Brady Urological Institute Johns Hopkins Medical Institutions

If PSA is Undetectable After Surgery, No Need for Rectal Exam



Men hate the digital rectal examination -- so much so, in fact, that the desire to avoid it may lead them to put off follow-up visits to the doctor after radical prostatectomy. From a medical standpoint, in turn, the rectal exam is only as good as the physician performing it. Similarly, another test often used in follow-up monitoring of prostate cancer patients after surgery, the radionuclide bone scan, is expensive and also may lead to further tests if the findings are inconclusive.

Is there a better way? A Hopkins study led by urologist Charles R. Pound, M.D., found that PSA is such a sensitive marker of prostate cancer that if the PSA is undetectable, men don't need a digital rectal examination or further imaging studies at that time. In other words, they're off the hook. (However, men still need careful follow-up with a PSA test every year.)

In the investigation, scientists studied the medical histories of nearly 2,000 men who underwent radical prostatectomy at Hopkins over a 15-year period -- a remarkable study of more than 10,000 patient- years of follow-up. Of these men, 56 developed a local recurrence of cancer, and 118 developed distant metastases. For some of these men, it took several years for cancer to return -- which is why men need to keep getting regular PSA tests, even several years after surgery -- but no man with an undetectable PSA had evidence of local recurrence or distant metastasis.



"Digital Rectal Examination and Imaging
Studies are Unnecessary in Men With An
Undetectable PSA Following Radical Prostatectomy."
Charles R. Pound, M.D., Owen W. Christens-Barry, 
Robin T. Gurganus, Alan W. Partin,M.D.,
Ph.D., and Patrick C. Walsh, M.D.,
Journal of Urology, Vol. 162: 1337-1340, 1999. 


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