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Rising prostate-specific antigen level after prostatectomy.

57-year-old man was referred to his urologist after a routine serum prostate-specific antigen (PSA) test revealed a level of 9.4 ng/mL. The patient denied any significant lower urinary tract voiding symptoms. He was sexually potent and denied any family history of prostate cancer. Urine dip analysis showed no evidence of hematuria or urinary tract infection. Digital rectal examination revealed a 30-g prostate without induration or nodularity. Because of the elevated serum PSA level, the patient underwent transrectal, systematic sextant, ultra-sound-guided prostate biopsies at an outside urologist’s clinic. The biopsies were sent for pathologic analysis as site-specifically labeled samples. Of the 6 cores obtained, the right-sided cores at the mid-prostate and apical prostate revealed Gleason 8 (4 + 4) adenocarcinoma. The maximum length of cancer was 6 mm, or 50% of the apical core. Following the biopsy results, computed tomography (CT) of the pelvis and a bone scan demonstrated no evidence of lymphadenopathy or bone metastasis. The patient dis-cussed various options with his urologist, who referred him to us for further evaluation and treatment. After consultation with us, including review of the pathology, which confirmed the original findings, the patient opted for a radical retropubic prostatectomy and bilateral pelvic lymph node dissection. A repeat PSA measurement during his consultation 1 month after the biopsy revealed a level of 15.7 ng/mL, although the results were obtained from a different laboratory and manufacturer’s assay. Tumor markers drawn per a research protocol showed inter-leukin–soluble receptor and transforming growth factor ß levels of 38.3 ng/mL and