Distant metastasis after radical prostatectomy in patients without an elevated serum prostate specific antigen level.

Overview

BACKGROUND: Serum prostate specific antigen (PSA) is a sensitive indicator of prostate cancer recurrence after radical prostatectomy. Prostate cancer rarely recurs after radical surgery without PSA elevation. Of the few patients noted in the literature who had a recurrence of cancer without PSA elevation, all had local recurrence alone, except for one, who had bone metastases. METHODS: In the authors' series of 628 patients, PSA was the first indicator of recurrence in all but 2 (2.6%) of 77 patients with clinical T1-T3NxM0 classification prostate cancer. RESULTS: Two of our patients, despite having undetectable PSA levels, had distant recurrence, including one with multiple visceral (lung and brain) metastases. CONCLUSIONS: These two cases demonstrate that although uncommon, prostate cancer can recur and metastasize after radical prostatectomy without an increase in the serum PSA level.