Follow-up in prostate cancer patients: Which parameters are necessary?

Aim: In a retrospective study we examined whether follow-up of prostate can cer (PC) patients can be managed by using prostate-specific antigen (PSA) a s a unique tool as postulated recently. Patients and Methods: According to strict criteria established in the eighties, at our institution PC patients were monitored by PSA, prostatic acid phosphatase (PAP), alkaline phosphat ase (AP), digital-rectal examination, renal and bladder ultrasound every 3 months, abdominopelvic computerized tomography (CT) and bone scan every 6 m onths. Between 1988 and 1994, 80 patients with PC cancer were eligible (mea n follow-up 29.5, range 12-81 months). Patients were categorized into 4 gro ups: localized tumor (n = 44); lymph node metastases (n = 9); distant metas tases (n = 18), and lymph node and distant metastases (n = 9). The paramete rs mentioned were compared for the assessment of progression, regression an d stabilization of the disease. Results: Our examinations showed that PSA i s superior to all the other parameters used. In all groups, there were no p atients with progressive disease detected by PAP, AP, CT and bone scan, but not by PSA, PSA anticipated the other parameters in detecting progression by several months. Renal ultrasound, however, detected new hydronephrosis i n 6 patients with stable or decreasing PSA. Hydronephrosis; was caused by s urgery or radiotherapy, not by progressive PC. Conclusion: PSA can be used as a unique tool in the follow-up of PC patients in all stages. However, pa tients who underwent therapy potentially afflicting the urinary tract shoul d have additional renal and bladder ultrasound.