Follow-up after radical prostatectomy or radiation therapy for prostate cancer

The use of the serum marker prostate-specific antigen (PSA) has altered drastically the follow-up after prostate cancer. PSA is far superior to any other method of detecting recurrences after either radiation therapy or radical prostatectomy. Once the PSA reaches a nadir level after radiation therapy or becomes undetectable after radical prostatectomy, it should remain at that level. PSA provides a lead time of approximately 3 to 7 years prior to identification of recurrence or metastases by other traditional methods. The yield of diagnostic studies to identify the site of recurrence in patients with very low levels of PSA after radical prostatectomy is quite low. A substantial dilemma remains about optimal therapy once a rising PSA is identified.