Author Affiliation: Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
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.1- 5 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.
Scher HI. Management of Prostate Cancer After ProstatectomyTreating the Patient, Not the PSA. JAMA. 1999;281(17):1642–1645. doi:10.1001/jama.281.17.1642
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