Harvard Perspectives on Prostate Disease

Getting a closer look at prostate cancer

Molecular imaging may help determine the location and extent of disease — and point to the best treatment

Consider this scenario: A man diagnosed with prostate cancer undergoes a radical prostatectomy. His prostate-specific antigen level, or PSA, drops from 12 ng/ml to nearly zero. But several months later, his PSA begins rising yet again, indicating that his cancer might be making a comeback.

What now? This patient's CT and MRI scans show no evidence of cancer in other parts of the body, but they don't show cancer in the hollow where the prostate once was, either. So where exactly is the cancer? Will salvage radiation therapy to the hollow, also called the prostate bed or prostatic fossa, drop the PSA to negligible levels permanently? Or will radiation do little more than cause troublesome side effects while the cancer continues its forward march elsewhere? Should the patient instead opt for a systemic treatment, such as hormone therapy, to control the cancer and lower PSA?

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