| Sumario: | Significance & Background: Before the advent of prostate-specific antigen (PSA) testing, digital rectal exams (DREs) were the primary method for detecting local recurrence of prostate cancer following definitive treatment. DRE was widely employed after radiation therapy and occasionally after surgery, despite its limited sensitivity. With the introduction and adoption of PSA testing in the late 1980s, surveillance shifted toward this more sensitive marker. Still, transition away from routine DRE has required sustained education and evidence-based guidance for providers and patients. Purpose: In post-radiation therapy follow-up, PSA trends are a critical indicator of treatment response. PSA decline can take up to 18-24 months, and rising values are the earliest and most reliable signs of treatment failure. DRE lacks the sensitivity to detect biochemical or microscopic recurrence. After prostatectomy, DRE is not clinically useful due to the absence of the prostate. Furthermore, post-radiation fibrosis and scarring may mimic recurrence, leading to false positives and unnecessary interventions. This highlights the need to prioritize PSA kinetics in modern surveillance. Interventions: Following multidisciplinary collaboration discussions among radiation oncologists, medical oncologists, and urologic surgeons, consensus was reached to adopt PSA as the primary surveillance tool. PSA testing, obtained through a simple blood draw, is processed in certified laboratories and securely stored in electronic medical records. To assess the effect of this shift, practice patterns were reviewed with attention to adherence to surveillance protocols and the frequency of unnecessary exams or interventions. Results: Initial findings show stronger adherence to recommended surveillance protocols and fewer unnecessary invasive exams. This reflects a clear transition toward PSA-based monitoring consistent with national guidelines. Discussion: While DRE may still have selective value when PSA is rising or imaging is suspicious, PSA remains the cornerstone of surveillance. Current NCCN guidelines no longer mandate routine DRE but allow for its use when clinically indicated.
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