One consequence of the routine adoption of PSA monitoring after treatment of early stage prostate cancer is the identification of men with a PSA-only recurrence. In this situation, increases in serum PSA over the pretreatment baseline are not accompanied by signs or symptoms of progressive disease. If the rise in the PSA is slow and occurs after a prolonged period, the site of relapse is generally at the site of the original tumor. Since a significant number of these men are relatively young and otherwise healthy, intense interest has been focused upon their treatment, with particular attention to survival, and the impact of therapy on quality of life.
Treatment options for men with a PSA-only recurrence after radical prostatectomy include external beam radiation therapy (RT) to the prostatic bed with or without treatment of the pelvic lymph nodes (salvage RT), androgen deprivation therapy (ADT), a combination of salvage RT plus ADT, or observation. Most of the available data regarding these approaches has come from observational series. Long-term results of randomized clinical trials will be required to define the optimal approach.
After prostatectomy, PSA should be 0.0 or close to zero. Rising PSA suggests failure even if the absolute PSA values is low.There is some controversy on whetehr any PSA rise warrants re-treatment or whether the PSA Velocity should be used to predict when to intervene.
Wiegel T, Lohm G, Bottke D, et al. Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome--results of a retrospective study. Int J Radiat Oncol Biol Phys 2009; 73:1009.
Trock BJ, Han M, Freedland SJ, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 2008; 299:2760.
Boorjian SA, Karnes RJ, Crispen PL, et al. Radiation therapy after radical prostatectomy: impact on metastasis and survival. J Urol 2009; 182:2708.
Andrew J. Stephenson, Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy , JAMA. 2004;291:1325-1332
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