American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for men with persistently elevated serum prostate-specific antigen right after prostate surgery?

1. Observation

2. Androgen deprivation therapy

3. Surgical re-exploration

4. Chemotherapy with cabazitaxel

The correct answer is: Androgen deprivation therapy

The recommended treatment for men with persistently elevated serum prostate-specific antigen (PSA) following prostate surgery, such as a radical prostatectomy, is androgen deprivation therapy (ADT). This elevation in PSA may signal that there are still prostate cancer cells present in the body, indicating a risk of recurrent or metastatic disease. Androgen deprivation therapy works by reducing levels of male hormones (androgens) like testosterone, which prostate cancer cells often rely on for growth and survival. By lowering these hormone levels, ADT can effectively slow down or shrink the progression of prostate cancer in patients with detectable PSA levels after surgical intervention. This therapeutic approach is supported by clinical guidelines and studies demonstrating its efficacy in managing advanced or recurrent prostate cancer. In contrast, observation may be appropriate in cases where there is no evidence of aggressive disease or metastasis, but in the face of persistently elevated PSA levels, more proactive treatment is generally recommended. Surgical re-exploration might be considered in cases of localized recurrence where there is a reasonable chance of surgical salvage but is not the first-line approach. Chemotherapy with cabazitaxel is typically reserved for advanced or hormone-resistant prostate cancer, making it less suitable in the context of a patient with new post-surgical elevated PSA levels.