TREATMENT OPTIONS FOR LOCALIZED RECURRENCE OF PROSTATE CANCER FOLLOWING RADIATION THERAPY - 11/09/11
Resumen |
Radiation therapy, either external beam irradiation or brachytherapy, remains a popular therapeutic modality for clinically organ-confined (stages T1 and T2) or locally invasive (stage T3) prostate cancer.19 Despite its popularity, a significant number of patients develop either biochemical or palpable local recurrence after treatment. Although the antitumor effects of radiation develop over several months and histologic resolution of the tumor may take more than 30 months,7 it is apparent that a positive posttreatment biopsy portends eventual clinical local recurrence and a negative biopsy cannot exclude recurrence. Up to 75% of patients with a positive biopsy after irradiation develop local recurrence within 10 years of therapy, as do 25% of those with a negative biopsy.40 Furthermore, local recurrence of prostate cancer after radiation therapy is often associated with the development of distant metastasis and ultimately death,10, 31, 39 with a median survival following detection of only 33 months.13 Thus, a positive postirradiation biopsy indicates failure to achieve adequate local control of disease with significant resultant risk for both local and distant progression.
The advent of prostate-specific antigen (PSA) has provided a potent tool for monitoring the therapeutic response of localized prostate cancer. Following radiation therapy, a patient's serum level typically falls to a low but detectable value.9 The decline in serum PSA concentration, like the histologic clearance of the tumor, develops over a period of 12 months or more.12, 35, 38 Although no specific posttreatment PSA level is indicative of long-term cure, Geist11 reported that a stable value of 0 to 2 ng/mL correlates with cancer control and Zagars37 reported that a PSA level above this value 3 months after treatment indicates a worse prognosis. Regardless of the absolute value, a rising PSA level can be detected in up to 80% of patients 5 years after therapy.34 The relationship between such biochemical recurrence and biologically significant recurrence is the subject of considerable controversy. Nevertheless, detection of a rising PSA level after radiation therapy signals the presence of active local or distant recurrence and should prompt restaging if salvage therapy is considered.
Certainly, the impact of salvage therapy on the patient's quality of life and longevity must be carefully evaluated within the context of existing comorbidities. It should be kept in mind, however, that the patient who undergoes treatment of localized prostate cancer in the form of radiation therapy with curative intent has been selected for active treatment of his disease rather than observation. For this reason, the detection of recurrence after radiation therapy, either biochemical or histologic, signals the need for consideration of further therapy. The therapeutic options for these patients are the subject of this article.
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| Address reprint requests to Louis L. Pisters, MD, Department of Urology—Box 110, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 This article is supported in part by ACS COE No 95-190-1. |
Vol 23 - N° 4
P. 677-684 - novembre 1996 Regresar al número
Artículo precedente
- SERUM PROSTATE-SPECIFIC ANTIGEN ELEVATION IN THE POST–RADICAL PROSTATECTOMY PATIENT
- S. Bruce Malkowicz
- NEW APPROACHES TO ADJUVANT THERAPY FOR PATIENTS WITH ADVERSE HISTOPATHOLOGIC FINDINGS FOLLOWING RADICAL PROSTATECTOMY
- William G. Nelson, Jonathan W. Simons
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