A high pre-treatment PSA is associated with a poor prognosis. PSA levels fall rapidly to undetectable levels after complete removal of a tumour by radical prostatectomy. The rate of fall is slower and the nadir higher after successful radiotherapy or endocrine therapy. A serial rise in PSA frequently precedes other evidence of disease progression in the patient with a past history of prostate cancer. Development of bone pain in the presence of an elevated PSA level suggests the development of bone metastases.
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