Diagnosis and management of biochemical recurrence in patients with prostate cancer who received definitive treatment

Definitif tedavi alan prostat kanserli hastalarda biyokimyasal nüksün tanı ve tedavisi

Özet

After deÀnitive treatment, recurrence is seen in some patients, as manifested by a rise in prostate-speciÀc antigen (PSA) before clinical progression. Biochemical recurrence (BCR) may herald a life-threatening situ- ation or be an insigniÀcant Ànding. The deÀnition of BCR depends on the treatment. There is no standard- ized deÀ nition of BCR after radical prostatectomy (RP). The BCR threshold ranges between 0.2 and 0.6 ng/ mL. According to the 1997 American Society for Therapeutic Radiology and Oncology (ASTRO) criteria, BCR after radiotherapy (RT) is 3 consecutives rise or, according to the 2005 consensus panel, 2 or 3 ng/mL rises above the nadir PSA. The clinical course of BCR can be very variable. In some cases, rapid progres- sion and metastasis can develop, whereas in others clinical progression may not occur. An increased risk of clinical progression in patients with BCR is correlated with time to BCR, prostatectomy Gleason score, and PSA doubling time (PSA-DT). An important parameter in determining the treatment option in patients with BCR is systemic or localized BCR. Local recurrence can be detected with a physical examination, imaging techniques, PSA kinetics, and clinicopathological Àndings. When a tumor is detected with current imaging techniques and biopsy, it may be too late to begin deÀnitive treatment. In patients with BCR after RP, the treatment options are RT and hormone therapy. The BCR-free survival with RT is better when applied at a low PSA threshold. The other important parameters affecting BCR-free survival are the RT dose, total Gleason score, surgical margins, extraprostatic extension, seminal vesicle invasion, and PSA-DT before RT. Treatment options for patients with BCR after RT are RP, brachytherapy, and cryotherapy. Although the morbidity rates were very high in early RP series, contemporary salvage RP series have more acceptable morbidity rates and improvements in local and distant cancer control.

Abstract

After deÀnitive treatment, recurrence is seen in some patients, as manifested by a rise in prostate-speciÀc antigen (PSA) before clinical progression. Biochemical recurrence (BCR) may herald a life-threatening situ- ation or be an insigniÀcant Ànding. The deÀnition of BCR depends on the treatment. There is no standard- zed deÀ nition of BCR after radical prostatectomy (RP). The BCR threshold ranges between 0.2 and 0.6 ng/ mL. According to the 1997 American Society for Therapeutic Radiology and Oncology (ASTRO) criteria, BCR after radiotherapy (RT) is 3 consecutives rise or, according to the 2005 consensus panel, 2 or 3 ng/mL ises above the nadir PSA. The clinical course of BCR can be very variable. In some cases, rapid progres- ion and metastasis can develop, whereas in others clinical progression may not occur. An increased risk of clinical progression in patients with BCR is correlated with time to BCR, prostatectomy Gleason score, and PSA doubling time (PSA-DT). An important parameter in determining the treatment option in patients with BCR is systemic or localized BCR. Local recurrence can be detected with a physical examination, imaging echniques, PSA kinetics, and clinicopathological Àndings. When a tumor is detected with current imaging echniques and biopsy, it may be too late to begin deÀnitive treatment. In patients with BCR after RP, the reatment options are RT and hormone therapy. The BCR-free survival with RT is better when applied at a low PSA threshold. The other important parameters affecting BCR-free survival are the RT dose, total Gleason score, surgical margins, extraprostatic extension, seminal vesicle invasion, and PSA-DT before RT. Treatment options for patients with BCR after RT are RP, brachytherapy, and cryotherapy. Although the morbidity rates were very high in early RP series, contemporary salvage RP series have more acceptable morbidity rates and improvements in local and distant cancer control.