A 65-year-old man with prostate cancer (PSA 8 ng/mL, Gleason 3+4=7, clinical stage T2a) undergoes radical prostatectomy. Pathology reveals positive surgical margins at the apex. Post-op PSA at 6 weeks is 0.08 ng/mL. What is this biochemical finding called and what is the threshold for initiating salvage radiotherapy?
- A Biochemical recurrence (BCR); salvage RT when PSA ≥0.2 ng/mL ✓
- B PSA persistence; salvage RT when PSA ≥0.1 ng/mL on a single reading
- C Normal variation; no treatment until PSA reaches 2.0 ng/mL
- D Residual benign tissue; no further treatment needed
Correct answer: A. Biochemical recurrence (BCR); salvage RT when PSA ≥0.2 ng/mL
Explanation
PSA >0.2 ng/mL confirmed on two consecutive measurements after radical prostatectomy defines biochemical recurrence (BCR). PSA should be undetectable (<0.1 ng/mL) after successful radical prostatectomy. The AUA/EAU guidelines recommend salvage radiotherapy (SRT) to the prostate fossa when PSA rises to ≥0.2 ng/mL. Current evidence from the RAVES and GETUG-AFU 17 trials supports SRT over immediate adjuvant RT in patients with positive margins but detectable PSA. Early SRT at lower PSA values (<0.5 ng/mL) achieves better outcomes.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.