EVALUATION AND MANAGEMENT OF THE MAN WHO HAS FAILED PRIMARY CURATIVE THERAPY FOR PROSTATE CANCER
Section snippets
Defining Disease Recurrence
Serum PSA measurement is by far the most useful and reliable test to diagnose recurrent prostate cancer after radical prostatectomy. Because serum PSA is produced almost exclusively by prostatic epithelial cells, persistently detectable (beyond the time of expectant clearance) or subsequent rising PSA levels usually indicate treatment failure. Most men with recurrent prostate cancer after surgery have detectable serum PSA levels. Conventional PSA assays such as the Hybritech Tandem-R have
Defining Treatment Failure
Measurements of PSA are now widely used as a surrogate end point to determine treatment failure and disease progression after definitive radiotherapy for clinically localized prostate cancer. Because the prostate remains in situ, failure to achieve an undetectable PSA level may not be indicative of treatment failure as it is following radical prostatectomy. Because of this fact, many different definitions have been used to define biochemical recurrence, with a resulting large variation in
Defining Treatment Failure
Failure after cryosurgical ablation has not been clearly defined. Connolly and co-workers25 described a group of 147 men who underwent primary cryoablation. At 3 months postprocedure, biopsies were performed in all of the men, and the mean PSA was 0.7 ng/mL and 1.2 ng/mL in men with negative and positive biopsies, respectively. By 12 months, the mean PSA in men with positive biopsies increased to 2.5 ng/mL, whereas the mean PSA in men with negative biopsies remained at 0.4 ng/mL. All men with
HORMONAL THERAPY IN MEN FAILING DEFINITIVE LOCAL THERAPY
The optimal timing and form of androgen ablation for men with asymptomatic local or distant recurrences following radical prostatectomy, external beam radiation, or cryoablation is a widely debated and highly controversial topic. To date, there has been no convincing evidence proving that early initiation of hormonal therapy improves long-term quality of life or survival. The majority of published studies have evaluated men with clinically advanced disease (pelvic lymph node or bony metastasis)
SUMMARY
The recurrence of prostate cancer after potentially curative local therapy is becoming a significant urologic problem. There are few prospective randomized trials, and the optimal diagnostic and treatment strategies for men who fail potentially curative therapy are not known. The experience to date seems to suggest the following as a reasonable approach.
A detectable serum PSA level (≥ 0.4 ng/mL) after radical prostatectomy is evidence of residual or recurrent prostate cancer. Men with low- or
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Cited by (37)
Imaging in Prostate Carcinoma
2013, Hematology/Oncology Clinics of North AmericaCitation Excerpt :With PSA levels less than 10 ng/mL, it is rare to see radiographic evidence of disease. The challenge is that men with localized recurrence in the prostate bed may benefit from targeted radiotherapy to this area, but we are limited to postprostatectomy PSA level, prostatectomy pathologic condition, and PSA doubling time to predict which men have only localized disease and will benefit from radiation therapy.73 MRI may be helpful after brachytherapy to evaluate seed placement and identify sites of developing disease.74
Prostate PDT dosimetry
2006, Photodiagnosis and Photodynamic TherapySelecting a secondary treatment
2003, Urologic Clinics of North AmericaMarkers and meaning of primary treatment failure
2003, Urologic Clinics of North AmericaPathophysiologic mechanisms in postprostatectomy urinary incontinence
2017, Post-Prostatectomy Incontinence: Evaluation and Management
Address reprint requests to Gerald L. Andriole, MD, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, St. Louis, MO 63110