A 70-year-old man in excellent health opted for annual PSA screening with a primary care physician. His initial PSA value was 8.3 ng/mL; on a repeat test, it was 9.0 ng/mL. A needle biopsy revealed Gleason 4+4 disease in 6 of 12 cores. He underwent robotic-assisted radical prostatectomy with pelvic lymph node dissection. His surgery and recovery were uncomplicated, but 2 years later his PSA becomes detectable (3.0 ng/mL) with no evidence of metastatic disease. He undergoes salvage radiotherapy with a 6-month course of adjuvant androgen depravation therapy (ADT). His nadir PSA is 0.5 ng/mL. His PSA level rose to 3.0 ng/mL 2 years later. Workup still does not reveal any evidence of metastatic disease.
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