PROSTATE-SPECIFIC ANTIGEN AFTER RADIATION THERAPY : Prognosis by Pretreatment Level and Post-treatment Nadir - 11/09/11
Résumé |
The availability of post-treatment serum prostate-specific antigen (PSA) levels provides a more precise identification of persistent disease after treatment for localized prostate cancer. Post-treatment serum PSA level has become the primary risk factor for predicting success or likelihood of clinical treatment failure. In addition, the pretreatment serum PSA level now is recognized as a critical prognostic parameter, equally or more so than stage and grade, in estimating the likelihood of a subsequently rising PSA level after a definitive therapy.8, 16, 18, 23, 24, 25, 39, 41 Several cautions are warranted. The assumption that a rising PSA level serves as a surrogate end point that correlates with survival has not been validated.31 Although the qualitative implication of a rising PSA level after therapy for local disease is persistent and progressive disease, there is insufficient data to quantitate time intervals from PSA failure to first symptoms, disease progression, or death for the individual patient. The detection of a rise in PSA presents the physician with the dilemma of what treatment to recommend, when to initiate the treatment, and how to assess the impact of the treatment on quantity and quality of life. Furthermore, information has arisen to call into question the previously unquestioned organ specificity of PSA. Although PSA expression in cells of the perianal and periurethral glands can be explained by embryologic or anatomic proximity to the prostate, this 30-kd serine protease also has been found in normal and malignant breast tissue, ovary, endometrium, colon, liver, kidney, and, in fact, virtually any tissue expressing hormone receptor activity.7
This article specifically discusses the prognostic value of the PSA level before external beam radiation therapy and the role of post-treatment PSA nadir level in predicting progression-free survival.
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| Address reprint requests to Paul F. Schellhammer, MD, The Sentara Cancer Institute, 600 Gresham Drive, Suite 203, Norfolk, VA 23507–1999 |
Vol 24 - N° 2
P. 407-414 - mai 1997 Retour au numéro
Article précédent
- PROSTATE-SPECIFIC ANTIGEN AFTER ANATOMIC RADICAL RETROPUBIC PROSTATECTOMY : Patterns of Recurrence and Cancer Control
- Charles R. Pound, Alan W. Partin, Jonathan I. Epstein, Patrick C. Walsh
- PROSTATE-SPECIFIC ANTIGEN AFTER CRYOSURGICAL ABLATION OF THE PROSTATE : Defining the Appropriate Response
- John A. Connolly, Katsuto Shinohara, Joseph C. Presti, Peter R. Carroll
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