Workup/Staging

Question 1

For men with rising PSA (and no other Sx of Dz) after definitive local Tx for prostate cancer, what is the utility of imaging studies in the workup?

Answer 1

For men with biochemical-only recurrence after definitive local Tx for prostate cancer, the yield of imaging studies is low. The likelihood of a positive bone scan is <5% if PSA <10 ng/mL, though time to PSA relapse and PSA kinetics can change pretest probability. (18F)-fluorocholine and fluciclovine-(18F) PET/CT may offer improved sensitivity, though further investigation of these tests is warranted.

Question 2

What is the utility of prostate Bx for men with a rising PSA (and no other Sx of Dz) after definitive prostate RT?

Answer 2

For post-RT pts with prostate cancer, TRUS prostate Bx is typically not recommended unless local salvage options are being considered, such as prostatectomy. Bx should be performed at least 18 mos after RT completion.

Question 3

What is the utility of prostate bed Bx for men with a rising PSA (and no other Sx of Dz) after radical prostatectomy?

Answer 3

This is controversial, and most recurrences are at the anastomotic site. Palpable prostate bed nodules should probably be biopsied and perhaps given higher doses of RT.