Adjuvant and Salvage Treatment for Prostate Cancer
Background
What % of newly diagnosed prostate cancers are cT3 Dz or higher?
12%–28% of men with newly diagnosed prostate cancer have cT3 Dz or higher.
In which portion of the prostate is ECE most commonly found?
ECE is most commonly found in the posterolat portion of the prostate, near the prostatic neurovascular bundle.
Name the most important factors in predicting Dz recurrence in pts undergoing local therapy for prostate cancer.
Pre-Tx PSA, Gleason score, ECE, and +margins are the most important factors in predicting Dz recurrence in pts undergoing local therapy for prostate cancer.
What is the American Urological Association (AUA) definition of biochemical recurrence s/p radical prostatectomy?
The AUA definition of biochemical recurrence s/p radical prostatectomy is a serum PSA ≥0.2, confirmed by a 2nd determination also ≥0.2.
What is the mean time to PSA nadir after RT for localized prostate cancer?
The mean time to PSA nadir after RT for localized prostate cancer is ~18 mos. Though there are contradictory reports, it seems that the rate of decline in PSA does not appear to correlate with risk of Dz recurrence.
Is there an absolute threshold for PSA nadir (with respect to Tx failure) after RT for localized prostate cancer?
The PSA nadir after RT for localized prostate cancer is a strong prognostic indicator of Tx success, but there is no absolute level below which the PSA must fall in order to define Tx success vs. failure.
What is the original ASTRO criterion (1996 consensus panel) for defining biochemical recurrence after RT for localized prostate cancer?
In order to be sure that the PSA is truly rising, the original ASTRO criteria for defining biochemical recurrence after RT for localized prostate cancer required 3 consecutive PSA rises following a nadir. The date of biochemical recurrence was defined as halfway between the nadir and date of 1st rise or any rise enough to provoke initiation of therapy.
What is the Phoenix criterion (2005 consensus panel) for defining biochemical recurrence after RT for localized prostate cancer?
Partly to eliminate concerns about the “backdating” associated with the original ASTRO definition, the Phoenix criterion for defining biochemical recurrence after RT for localized prostate cancer is a PSA rise of ≥2 ng/mL above the PSA nadir, regardless of the presence of androgen deprivation therapy (ADT). The date of recurrence is the date of the PSA that triggers the definition. This definition is also considered to be useful for pts treated with EBRT and neoadj hormone therapy.
What is the concept of “PSA bounce” in pts who rcv RT for localized prostate cancer? How should it be managed?
After RT for localized prostate cancer, serum PSA typically falls. However, it can rise transiently, called a PSA bounce, usually around 12–18 mos after Tx. This can occur even without Dz recurrence. The frequency of this occurrence varies depending on the definition of biochemical recurrence. Using the Phoenix definition, it can occur in 10%–20% of pts. There is no definitive method to distinguish a PSA bounce from recurrent Dz. The PSA should be rechecked 3–6 mos later and managed accordingly.
Workup/Staging
What is the primary purpose of diagnostic evaluation for men with rising PSA after definitive local Tx for prostate cancer?
The primary purpose of diagnostic evaluation for men with rising PSA after definitive local Tx for prostate cancer is to distinguish pts most likely to have isolated local relapse vs. pts with systemic Dz.
For men with rising PSA (and no other Sx of Dz) after definitive local Tx for prostate cancer, what is the utility of imaging studies, such as bone scan, CT, MRI, and ProstaScint?
For men with rising PSA (and no other Sx of Dz) after definitive local Tx for prostate cancer, the likelihood of a positive bone scan is <5% unless the PSA is >40 ng/mL.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
