Algorithmic approach to rising PSA after curative prostate cancer treatment

Aim: To review the current approach in prostate cancer patients with increasing PSA after the application of curative treatments.Results: PSA elevations above certain criteria indicate "biochemical relapse" (BR) and leads salvage treatments. Recurrence is defined as two consecutive elevations over 0,2 ng/ml following radical prostatectomy and elevations of 2 ng/ml over PSA nadir following external beam radiotherapy (EBRT). PSA doubling time (PSADT), Gleason score and disease stage are the frequently used prognostic parameters for differential diagnosis of systemic or local recurrences. Imaging modalities lack sensitivity in lower PSA values. The time to recurrence is an important factor for decision of local salvage and systemic therapies.Conclusion: Role of PSA in follow up of patients treated with curative intend is more important than it is in prostate cancer screening. None of the salvage modalities were shown to have significant positive effects on overall survival, yet. The time to recurrence is a critical point for differentiation of local or systemic recurrences.