PSA recurrence: definitions, PSA kinetics, and identifying patients at risk

Uncertainty exists for clinicians and patients with respect to choosing the optimal therapy for patients with PSA recurrence. There is no consensus as to what the PSA cutpoint should be to define PSA failure after radical prostatectomy (RP) or radiation therapy (XRT). We do, however, have validated nomograms which allow the stratification of patients according to their risk of disease progression and cancer specific death. This is based in large part on PSA kinetics. A short PSA doubling time (PSA-DT) is associated with a marked increase in the risk of prostate cancer death in the 5-10 year time frame. PSA DT can also be used to identify patients most likely to respond to local salvage therapy.