A rising PSA after prostatectomy is recurrent cancer until proven otherwise. The time course listed in the email is not clear, as a prostatectomy performed in 1994 would be almost 10 years out from surgery. If this rise has occurred over this long a period, then clearly, what ever the cause is, it is certainly not aggressive or life threatening. And also clearly, observation has been chosen as the management option for the last 8 of those years. Benign prostate glands left behind at the time of surgery can be a source of PSA after surgery, but we assume this only when cancer has been ruled out. I would not recommend hormonal therapy in this instance unless there was a dramatic rise in PSA or clinical evidence of progression. I would recommend a bone scan, a CT of the abdomen and pelvis, and a transrectal ultrasound with possible biopsy of the anastamosis. If benign glands are seen on the biopsy, I would continue to observe you. If cancer is present I would consider radiation therapy to the prostate bed for cure. If neither is seen, I would continue to follow you with the above studies performed once a year or so until a definitive answer is arrived at. Following the PSA until a dramatic change occurs or there is clinical evidence of cancer progression (if the above studies are negative or uninformative) is reasonable. I think hormone therapy in this case is over treatment. A PET scan may also shed some light if the above mentioned studies are in fact negative. There are numerous references you can refer to on Pub Med regarding rising PSA after prostatectomy.

-Christopher Wood, M.D.