Post‑Prostatectomy PSA Monitoring and Management Guidelines

Definition of Biochemical Recurrence

The American Urological Association defines biochemical recurrence after radical prostatectomy as a PSA ≥ 0.2 ng/mL confirmed by a second measurement ≥ 0.2 ng/mL; this cut‑point was chosen to optimise sensitivity and specificity for detecting recurrence rather than to represent a biological threshold for disease presence. 1

Imaging for Confirmed Recurrence

When PSA reaches ≥ 0.2 ng/mL on two separate occasions, PSMA‑PET/CT is the preferred imaging modality to localise disease (local prostate‑bed, regional pelvic nodes, or distant metastases) and to guide salvage therapy decisions. 3

Surveillance Frequency

For patients after radical prostatectomy, PSA should be measured every 3 months during the first postoperative year and every 6 months thereafter if PSA remains undetectable. 4

Assay Consistency

The same PSA assay platform should be used throughout follow‑up to avoid inter‑method variability of approximately ±25 %. 5

PSA Doubling Time as a Risk Indicator

If a detectable PSA is observed, repeat testing and calculation of PSA doubling time (PSADT) are recommended; a PSADT ≥ 15 months is associated with a low risk of prostate‑cancer‑specific mortality over 10 years. 6

Impact of Immunosuppression in Transplant Recipients

Kidney‑transplant recipients experience a ~7‑fold higher incidence of prostate cancer (≈ 1,126 vs 160 per 100,000) and present more frequently with advanced disease (≈ 36 % T3/T4, 19 % metastatic), although cancer‑specific survival after treatment is comparable to the general population. 4