Follow-up in prostate cancer patients: which parameters are necessary?

In a retrospective study we examined whether follow-up of prostate cancer (PC) patients can be managed by using prostate-specific antigen (PSA) as a unique tool as postulated recently.

According to strict criteria established in the eighties, at our institution PC patients were monitored by PSA, prostatic acid phosphatase (PAP), alkaline phosphatase (AP), digital-rectal examination, renal and bladder ultrasound every 3 months, abdominopelvic computerized tomography (CT) and bone scan every 6 months. Between 1988 and 1994, 80 patients with PC cancer were eligible (mean follow-up 29.5, range 12-81 months). Patients were categorized into 4 groups: localized tumor (n = 44); lymph node metastases (n = 9); distant metastases (n = 18), and lymph node and distant metastases (n = 9). The parameters mentioned were compared for the assessment of progression, regression and stabilization of the disease.

Our examinations showed that PSA is superior to all the other parameters used. In all groups, there were no patients with progressive disease detected by PAP, AP, CT and bone scan, but not by PSA. PSA anticipated the other parameters in detecting progression by several months. Renal ultrasound, however, detected new hydronephrosis in 6 patients with stable or decreasing PSA. Hydronephrosis was caused by surgery or radiotherapy, not by progressive PC.

PSA can be used as a unique tool in the follow-up of PC patients in all stages. However, patients who underwent therapy potentially afflicting the urinary tract should have additional renal and bladder ultrasound.