No immediate treatment after biochemical failure in patients with prostate cancer treated by external beam radiotherapy

Objectives. The treatment of patients with asymptomatic prostate cancer with biochemical failure (BF) remains controversial. The early introduction of hormonal therapy causes important secondary effects and increases costs. Our general policy has been to follow-up patients with low prostate-specific antigen (PSA) levels and a long PSA doubling time without therapy. We report our experience using such an approach. Methods. Between 1992 and 2000, 676 patients with localized prostate cancer were treated with radical radiotherapy, with or without adjuvant hormonal therapy at our institution. Asymptomatic patients with BF, no clinical evidence of metastatic disease, a low PSA level, and long PSA doubling time were considered for follow-up without immediate hormonal therapy. The prognostic factors such as stage and Gleason score were not considered when electing follow-up without additional therapy. The follow-up included at least two annual visits with physical examination and PSA determination. Results. With a median follow-up of 85 months, 285 patients (42%) had BF In 178 of these men, the rising PSA level was the only abnormality. Of these, 113 were followed up without additional therapy and 65 received hormonal therapy. Of the 113 patients in the untreated group, 101 (89%) were alive and asymptomatic at the last follow-up visit and 12 (11%) had died of causes other than prostate cancer. The long-term outcomes were similar in both groups. Conclusions. Expectant management, without initial hormonal therapy, may be a reasonable option for selected patients with prostate cancer who present with BF without metastatic disease after radical external beam radiotherapy. This decision is important because the early introduction of hormonal therapy is associated with side effects and is expensive.