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Am Fam Physician. 2000;61(5):1481

The routine follow-up after a radical prostatectomy is digital rectal examination and annual prostate specific antigen (PSA) testing for surveillance of recurrent cancer. Included in that routine evaluation is radiographic evaluation of the bones for metastatic disease. The digital rectal examination is uncomfortable, and the findings are dependent on the skill of the examiner. Any radiographic bone evaluation is expensive. Pound and associates studied the necessity of performing digital rectal examinations and radiographic bone assessments in men with resected prostate cancer with an undetectable serum PSA level.

The study included 1,944 men who received a radical retropubic prostatectomy for prostate cancer during a 14-year period (May 1982 to June 1996). Twenty-nine of the participants were lost to follow-up. All remaining patients were followed with postoperative digital rectal examinations and serum PSA assays twice during the first year and then annually. Any local or distant recurrences were documented. The average follow-up time was 5.5 years. In the study population, local recurrence developed in 57 men (2.97 percent), and distant recurrence developed in 118 men (6.2 percent). Of those with local recurrences, 50 patients had detectable PSA levels (greater than 0.2 ng per mL). None of the men without local or distant recurrence had detectable PSA levels.

The authors conclude that it is extremely rare for men treated solely with radical prostatectomy for localized prostatic cancer to have recurrence with undetectable serum PSA levels. They recommend that digital rectal examination and radiographic bone evaluation be eliminated from the routine follow-up of patients with undetectable PSA levels after radical prostatectomy. The authors note that eliminating the digital rectal examination will increase compliance with routine follow-up as patients avoid the discomfort this examination can cause.

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