VARIABLE HISTOLOGY OF ANASTOMOTIC BIOPSIES WITH DETECTABLE PROSTATE-SPECIFIC ANTIGEN AFTER RADICAL PROSTATECTOMY

Progressive elevation of the prostate specific antigen (PSA) level aft er radical prostatectomy for adenocarcinoma is generally considered as irrefutable evidence of recurrent tumor. We assessed the results of 6 2 biopsies of the vesicourethral anastomosis in 41 men who had 3 or mo re consecutive PSA levels of 0.4 ng./ml. or greater after radical pros tatectomy and no evidence of metastatic disease. The median PSA at the time of the first biopsy was 2.2 ng./ml. (range 0.4 to 50). Histologi cal confirmation of recurrent cancer was established after 1 biopsy pr ocedure in 39% of the patients and after 1 or more biopsy procedures i n 59%. Biopsy was positive in 78% of 23 patients with an abnormal digi tal rectal examination, 40% of 5 with an abnormal transrectal ultrasou nd only, and 23% of 13 with a normal digital rectal examination and ul trasound. Among the patients with and without biopsy proved tumor recu rrence there were no significant differences between the pathological stage or histological grade of the primary tumors, the month after sur gery of the first detectable PSA level, the PSA doubling time, the mon th after surgery of the positive biopsy or the last negative biopsy, a nd the PSA level at the time of the positive biopsy or the last negati ve biopsy. In 6 cases benign prostatic tissue only was recovered from 1 or more biopsy specimens. This experience demonstrates that in patie nts with a detectable PSA after radical prostatectomy recurrent cancer may be difficult to document by biopsy of the vesicourethral anastomo sis.