DIGITAL RECTAL EXAMINATION AND IMAGING STUDIES ARE UNNECESSARY IN MEN WITH UNDETECTABLE PROSTATE SPECIFIC ANTIGEN FOLLOWING RADICAL PROSTATECTOMY

ABSTRACTPurpose: We determine the probability of local or distant recurrence following radical prostatectomy in men with an undetectable prostate specific antigen (PSA) level.Materials and Methods: The clinical course of 1,916 consecutive men followed during a 14-year period after radical prostatectomy was reviewed. Average followup plus or minus standard deviation is 5.5 ± 3.5 years, and 326 men (17%) have been followed for more than 10 years. In total this population of men has been followed for 10,540 patient-years.Results: Of 1,916 men 56 (2.9%) had local recurrence an average of 6.1 ± 2.7 years (range 1 to 12) after surgery. No man had local recurrence with an undetectable serum PSA. Mean serum PSA at the time of local recurrence was 5.8 ng./ml. Of the 56 men 13 (25%) who had local disease recurrence had an undetectable serum PSA at 5 years of followup but had progression to biochemical and local disease recurrence later. Of 1,916 men 118 had distant metastases with a mean serum PSA of 28.6 ng./ml. N...