Biochemical failure after radical prostatectomy

An elevated or detectable serum PSA after radical prostatectomy for prostate cancer is significant in the great majority of the cases with recurrent or persistent disease. Elevation of serum PSA causes concern for the patient and his physician since the best way to treat these patients is yet unknown. Analysis of large series of patients who underwent radical prostatectomy demonstrates that as many as 30% of patients will experience biochemical relapse represented by elevation of serum PSA. Most of the relapses occur in the first 5 years. However, 10 to 15 years are necessary to ascertain the true clinical progression rate of prostate cancer after radical prostatectomy. The time lag between the biochemical and clinical manifestation of metastatic disease may extend for up to 8 years, followed by an additional 5-year median time until cancer specific death. Radiation therapy may be beneficial as an adjuvant or early salvage if PSA < 1.5ng/ml and for patients with high probability of local recurrence. Early salvage radiation therapy is a more acceptable option than adjuvant radiation therapy, saving 70% of patients with adverse pathology unnecessary treatment. Hormonal treatment at the time of biochemical relapse is justified in selected patients.