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May 5, 1999

Management of Prostate Cancer After ProstatectomyTreating the Patient, Not the PSA

Author Affiliations

Author Affiliation: Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY.

JAMA. 1999;281(17):1642-1645. doi:10.1001/jama.281.17.1642

MEASUREMENT OF THE LEVEL OF PROSTATE-specific antigen (PSA) in the blood has had a profound impact on the management of prostate cancer. Heated debates surround early detection and screening.15 Equally controversial is the use and interpretation of serial changes in PSA values for assessing outcomes and determining prognosis.6 For the patient who has undergone a radical prostatectomy, a persistent PSA value is a sign of residual disease, but an undetectable value does not necessarily mean cure. But what if the PSA value had been undetectable and then becomes detectable and continues to increase? A rising PSA value can predate other signs of progression by months or even years.7 Misinterpretation of the significance of the change in PSA levels can create havoc for patients who are profoundly concerned with their PSA determinations and for physicians who must address the anxieties and fears of their patients. Unfortunately, documentation of rising values also often triggers a cascade of expensive testing that can prompt the administration of treatments that may be unnecessary and, perhaps, more detrimental to the patient than the disease itself.

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