THE INCIDENCE OF PROSTATE-CANCER PROGRESSION WITH UNDETECTABLE SERUM PROSTATE-SPECIFIC ANTIGEN IN A SERIES OF 394 RADICAL PROSTATECTOMIES

Purpose: Serum prostate specific antigen (PSA) has been reported to be a sensitive indicator of recurrent carcinoma after radical prostatect omy but it is not absolute. Disease progression with undetectable PSA levels has been described but the incidence of this phenomenon is unkn own. Materials and Methods: We retrospectively analyzed the records of 394 consecutive men who underwent radical prostatectomy between 1980 and 1991 to characterize the incidence of recurrent carcinoma despite undetectable serum PSA levels. Results: Of the 394 men 133 had documen ted evidence of disease recurrence, 3 (2.3%) despite undetectable seru m PSA levels (2 had local and systemic evidence of disease progression ). Histological dedifferentiation characterized these recurrences. Con clusions: Although a post-prostatectomy detectable serum PSA level pre cedes clinical evidence of disease progression by years, rare patients (2.3% in our series) in whom recurrent disease is characterized by ma rked histological dedifferentiation will remain negative for PSA.