Although serum PSA alone does not differentiate local recurrence from distant metastatic disease, the patterns of PSA rise after failed primary therapy have been incorporated into clinical nomograms to predict whether recurrence is more likely local versus distant metastatic disease. Patients with late BCR (>24 months after local treatment), low PSA velocity (change in PSA over time), and/or prolonged PSADT (>6 months) most likely have recurrent local disease [7]. Conversely, patients with a rapid PSA recurrence (<24 months after local treatment), high PSA velocity, or short PSADT (<6 months) are more likely to have metastatic recurrence [7]. This can serve as a clinical guide in selecting the appropriate imaging test to confirm diagnosis. In evaluating patients with recurrent or metastatic prostate cancer, it is important to define the location, size, and extent of local and/or distant tumors. Use of more conventional imaging studies (eg, bone scan and CT) to document recurrent or metastatic disease using clinical parameters is challenging. Choueiri et al [1] demonstrated that with a PSA of <5 ng/mL and a PSADT <10 months, both scintigraphic bone scan and CT are very unlikely to detect the recurrence. The common sites of BCR after failure of definitive management are local recurrence and regional nodal metastasis [8,9]. Although early bone metastases can also be seen, bone metastases are relatively uncommon until later in the course of more advanced metastatic spread when serum PSA values correspondingly tend to also be aNational Cancer Institute, National Institutes of Health, Bethesda, Maryland. bPanel Chair, University of Chicago, Chicago, Illinois. cPanel Vice-Chair, Duke University Medical Center, Durham, North Carolina. dMemorial Sloan Kettering Cancer Center, New York, New York. eMayo Clinic, Jacksonville, Florida. fThe University of Chicago, Chicago, Illinois, Primary care physician. gMayo Clinic, Rochester, Minnesota.
Post Treatment Follow up of Prostate Cancer. Although serum PSA alone does not differentiate local recurrence from distant metastatic disease, the patterns of PSA rise after failed primary therapy have been incorporated into clinical nomograms to predict whether recurrence is more likely local versus distant metastatic disease. Patients with late BCR (>24 months after local treatment), low PSA velocity (change in PSA over time), and/or prolonged PSADT (>6 months) most likely have recurrent local disease [7]. Conversely, patients with a rapid PSA recurrence (<24 months after local treatment), high PSA velocity, or short PSADT (<6 months) are more likely to have metastatic recurrence [7]. This can serve as a clinical guide in selecting the appropriate imaging test to confirm diagnosis. In evaluating patients with recurrent or metastatic prostate cancer, it is important to define the location, size, and extent of local and/or distant tumors. Use of more conventional imaging studies (eg, bone scan and CT) to document recurrent or metastatic disease using clinical parameters is challenging. Choueiri et al [1] demonstrated that with a PSA of <5 ng/mL and a PSADT <10 months, both scintigraphic bone scan and CT are very unlikely to detect the recurrence. The common sites of BCR after failure of definitive management are local recurrence and regional nodal metastasis [8,9]. Although early bone metastases can also be seen, bone metastases are relatively uncommon until later in the course of more advanced metastatic spread when serum PSA values correspondingly tend to also be aNational Cancer Institute, National Institutes of Health, Bethesda, Maryland. bPanel Chair, University of Chicago, Chicago, Illinois. cPanel Vice-Chair, Duke University Medical Center, Durham, North Carolina. dMemorial Sloan Kettering Cancer Center, New York, New York. eMayo Clinic, Jacksonville, Florida. fThe University of Chicago, Chicago, Illinois, Primary care physician. gMayo Clinic, Rochester, Minnesota.