American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a risk factor for developing distant metastatic disease in prostate cancer patients post-surgery?

1. Low body weight

2. Persistently elevated serum prostate-specific antigen levels

3. Older age at diagnosis

4. Positive lymph nodes at diagnosis

The correct answer is: Persistently elevated serum prostate-specific antigen levels

Persistently elevated serum prostate-specific antigen (PSA) levels post-surgery are significant indicators of a higher likelihood of developing distant metastatic disease in patients with prostate cancer. PSA is a protein produced by both normal and malignant cells of the prostate gland, and its levels can provide insights into the cancer's behavior after treatment. When PSA levels remain elevated after radical prostatectomy, it suggests that residual cancer may be present. This residual disease can lead to further progression of the cancer and an increased risk of metastasis to distant sites, such as bones or lymph nodes outside the pelvic region. The presence of high PSA levels post-treatment is often associated with more aggressive tumor characteristics and a likelihood that the cancer has not been completely eradicated. Thus, monitoring PSA levels after surgery is crucial for assessing the risk of recurrence and potential metastatic disease. In contrast, factors such as low body weight, older age at diagnosis, or even positive lymph nodes may contribute to overall cancer risk profiles but are not as directly indicative of immediate post-surgical metastatic disease risk as persistently elevated PSA levels.