American Board of Internal Medicine (ABIM) Certification Practice Exam

How should a patient with rising prostate-specific antigen levels after prostatectomy be treated?

1. Hormonal therapy alone

2. Radiation therapy with androgen deprivation therapy

3. Active surveillance

4. Chemotherapy

The correct answer is: Radiation therapy with androgen deprivation therapy

In the context of rising prostate-specific antigen (PSA) levels after prostatectomy, the preferred treatment approach involves the combination of radiation therapy with androgen deprivation therapy. This strategy is particularly effective for patients who experience a biochemical recurrence, which is indicated by elevated PSA levels following surgical removal of the prostate. Radiation therapy targets any residual cancer cells that may remain in the pelvic area after surgery, reducing the risk of disease progression. Androgen deprivation therapy works to lower testosterone levels, which can fuel the growth of prostate cancer cells. By combining these two modalities, the treatment aims to address both local and systemic aspects of potential recurrence, thus enhancing treatment efficacy and improving patient outcomes. Other options, such as hormonal therapy alone, may not be sufficient to address the local disease that may be present post-surgery. Active surveillance is typically reserved for patients with low-risk, localized disease rather than those demonstrating rising PSA levels, as these patients require timely intervention to prevent further advancement of the disease. Chemotherapy, while effective in later-stage disease, is generally not the first line of treatment for recurrent prostate cancer detected through rising PSA levels, as hormonal therapies are more appropriate for these cases.