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

Abstract

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.