ABSTRACT
The routine use of prostate-specific antigen (PSA) analysis in men over 50 years of age since the early 1990s has revolutionized the diagnosis of prostate cancer. With the advent of PSA, early detection of prostate cancer is often possible before any symptoms or palpable abnormalities occur in the prostate. As a result, patients typically present for treatment with organconfined disease, and are subjected to a primary therapy modality with curative intent.1,2 Despite this, cancer recurrence following initial therapy is not uncommon. It has been estimated that each year in the USA alone, 50,000 men have PSA recurrence after either radical prostatectomy or radiation therapy.3 This typically precedes any clinical finding by 3 to 5 years.4 Although PSA elevation following primary therapy is a very sensitive predictor of subsequent clinical disease progression, it does not reliably distinguish between local recurrence and systemic (metastatic) disease. The distinction between these two entities is crucial in determining the next line of therapy and the patient’s prognosis. Generally, systemic disease is not amenable to curative therapy, and the goals of treatment in that setting are to preserve quality of life and minimize morbidity. Conversely, an isolated local recurrence following primary treatment has the potential of being cured by salvage therapy.
