Perhaps one of the most confusing problems for patients and urologists is the treatment of biochemical recurrence of prostate cancer. Essentially this means that PSA after definitive therapy starts to rise.

For someone who has had surgical extirpation this means that their PSA which had been zero starts to creep up slowly over time. For the men who have had primary treatment with some form of radiation, this means that they have had three successive rises in their PSA after a PSA nadir (their lowest PSA value.)

There are no great studies or “book” answers for how to treat biochemical recurrence of prostate cancer. Just as in the initial phases of decision making, patient preference and expectation are intrinsically involved in the decision making process.

Typically, a metastatic evaluation would be performed. This would often include a whole body nuclear bone scan which looks for metastatic activity in the skeletal frame. Often a CT scan of the abdomen and pelvis will be ordered looking for lymphadenopathy. A Prostascint scan which is another type of nuclear test which specifically targets prostate cancer cells is another radiologic test that will often be performed in the evaluation of biochemical recurrence of prostate cancer.

I had originally hoped to tackle biochemical recurrence in one blog and then realized how unrealistic I had been. We need to discuss each of the pathways of biochemical recurrence depending upon primary therapy and pathology. So a long conversation just became longer. But then, baseball season is over and it isn’t yet May. The NFL draft is only a few days away and training camp doesn’t start for months. I guess I’ll talk about prostate cancer.

Have a great week.