The effective management of biochemical recurrence in patients with prostate cancer

Prostate-specific antigen (PSA) testing has become the primary method of monitoring patients following definitive therapy for clinically localized prostate cancer. After surgery, an immediate detectable rise in PSA is correlated with subsequent local recurrence and/or metastasis. Following radiation therapy, biochemical failure is defined as 3 consecutive rises in PSA above the nadir. Treatment of postoperative or postradiation PSA recurrence involves several modalities, including luteinizing hormone-releasing hormone agonists. Although studies have demonstrated the advantages of early hormone therapy, they have not addressed at what PSA level treatment should begin. A better understanding of PSA's kinetics will lead to a sense of when to begin treatment and when watchful waiting is the more appropriate course.