Assessing and treating patients with increasing prostate specific antigen following radical prostatectomy

被引:26
作者
Sandler, Howard M.
Eisenberger, Mario A.
机构
[1] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48109 USA
[2] Johns Hopkins Univ, Dept Oncol, Baltimore, MD USA
[3] Johns Hopkins Univ, Sch Med, Dept Urol, Baltimore, MD 21205 USA
[4] Univ Michigan, Dept Urol, Ann Arbor, MI 48109 USA
关键词
prostatic neoplasms; radiotherapy; prostatic-specific antigen; prostate;
D O I
10.1016/j.juro.2007.04.034
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: In patients who undergo local treatment for clinically localized prostate cancer evidence of increasing serum prostate specific antigen usually antedates the development of clinically evident metastasis by many years. Prostate specific antigen is used to guide subsequent salvage strategies, such as postoperative radiotherapy, androgen ablation or active surveillance with delayed intervention. We discuss options for management in patients who have increasing prostate specific antigen after radical prostatectomy. Materials and Methods: The current status of treatment approaches was reviewed to provide an update on frequently used management strategies. Results: Increasing prostate specific antigen values of 0.2 to 0.4 ng/ml are used to indicate recurrent disease after surgery. Restaging is recommended to determine whether metastatic disease can be detected, although many patients with low prostate specific antigen values will have no detectable metastases. Local therapy should be used for select patients in the absence of metastases but the results are most satisfactory for relatively slowly increasing prostate specific antigen with values below 1.0 ng/ml and lower Gleason score neoplasms because these tumors are more likely to have localized recurrences. Conclusions: Current knowledge about patients with biochemical relapse after radical prostatectomy is primarily related to their natural history. Although approximately 70% of these patients are unlikely to die of the disease, they remain at risk for the development of metastasis and disease related morbidity. Currently no general consensus exists regarding standard systemic treatment approaches for these patients and inclusion in clinical trials remains the most important priority.
引用
收藏
页码:S20 / S24
页数:5
相关论文
共 21 条
[1]   Defining prostate specific antigen progression after radical prostatectomy: What is the most appropriate cut point? [J].
Amling, CL ;
Bergstralh, EJ ;
Blute, ML ;
Slezak, JM ;
Zincke, H .
JOURNAL OF UROLOGY, 2001, 165 (04) :1146-1151
[2]   Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: Continued rise of biochemical failure after 5 years [J].
Amling, CL ;
Blute, ML ;
Bergstralh, EJ ;
Seay, TM ;
Slezak, J ;
Zincke, H .
JOURNAL OF UROLOGY, 2000, 164 (01) :101-105
[3]   Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy [J].
Cher, ML ;
Bianco, FJ ;
Lam, JS ;
Davis, LP ;
Grignon, DJ ;
Sakr, WA ;
Banerjee, M ;
Pontes, JE ;
Wood, DP .
JOURNAL OF UROLOGY, 1998, 160 (04) :1387-1391
[4]   Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy [J].
D'Amico, AV ;
Moul, JW ;
Carroll, PR ;
Sun, L ;
Lubeck, D ;
Chen, MH .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2003, 95 (18) :1376-1383
[5]  
EISENBERGER MA, 2003, P AM SOC CLIN ONCOL, V22
[6]   Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy [J].
Feng, M ;
Hanlon, AL ;
Pisansky, TM ;
Kuban, DA ;
Catton, C ;
Michalski, JM ;
Zelefsky, MJ ;
Kupelian, PA ;
Pollack, A ;
Kestin, LL ;
Valicenti, RK ;
DeWeese, TL .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2005, 63 (02) :S127-S127
[7]   Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy [J].
Freedland, SJ ;
Humphreys, EB ;
Mangold, LA ;
Eisenberger, M ;
Dorey, FJ ;
Walsh, PC ;
Partin, AW .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 294 (04) :433-439
[8]  
FREEDLAND SJ, 2006, P AM SOC CLIN ONCOL, V24
[9]   Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy [J].
Kane, CJ ;
Amling, CL ;
Johnstone, PAS ;
Pak, N ;
Lance, RS ;
Thrasher, JB ;
Foley, JP ;
Riffenburgh, RH ;
Moul, JW .
UROLOGY, 2003, 61 (03) :607-611
[10]   Patterns of secondary cancer treatment for biochemical failure following radical prostatectomy: Data from CaPSURE [J].
Mehta, SS ;
Lubeck, DP ;
Sadetsky, N ;
Pasta, DJ ;
Carroll, PR .
JOURNAL OF UROLOGY, 2004, 171 (01) :215-219