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

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Author(s): Hasan Soydan | Kadir Baykal

Journal: Turkish Journal of Urology
ISSN 1300-5804

Volume: 37;
Issue: 4;
Start page: 295;
Date: 2011;
Original page

Keywords: Biochemical phenomena | diagnosis | prostate cancer | recurrence | treatment

ABSTRACT
After definitive treatment, recurrence is seen in some patients, as manifested by a rise in prostate-specific antigen (PSA) before clinical progression. Biochemical recurrence (BCR) may herald a life-threatening situation or be an insignificant finding. The definition of BCR depends on the treatment. There is no standardized definition 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 progression 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 findings. When a tumor is detected with current imaging techniques and biopsy, it may be too late to begin definitive 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.
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