Digital rectal examination and imaging studies are unnecessary in men withundetectable prostate specific antigen following radical prostatectomy

Purpose: We determine the probability of local or distant recurrence follow ing radical prostatectomy in men with an undetectable prostate specific ant igen (PSA) level. Materials and Methods: The clinical course of 1,916 consecutive men followe d 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 me n (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 a n undetectable serum PSA. Mean serum PSA at the time of local recurrence wa s 5.8 ng./ml. Of the 56 men 13 (25%) who had local disease recurrence had a n undetectable serum PSA at 5 years of followup but had progression to bioc hemical and local disease recurrence later. Of 1,916 men 118 had distant me tastases with a mean serum PSA of 28.6 ng./ml. No man has had distant metas tasis with an undetectable serum PSA. Conclusions: Disease can recur after radical prostatectomy even after an ex tended biochemical disease-free interval. None of the 1,916 men followed fo r an average of greater than 5 years after surgery had local recurrence or distant metastasis with an undetectable serum PSA. Based on these observati ons, we recommend no further evaluation, that is digital rectal examination or imaging studies, in men with an undetectable PSA following radical pros tatectomy.