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Eli Rosenbaum, Alan Partin and Mario A. Eisenberger

After local treatment, a substantial proportion of patients with prostate cancer present with rising prostate specific antigen (PSA) serum levels as the only indication of disease activity. Evolving data derived from large databases that were predominantly retrospectively evaluated show that the natural history of these patients is quite variable. Various clinical and pathologic parameters have been shown to predict for the probability of development of distant metastasis, including the surgical Gleason score, time of PSA relapse after primary treatment, and PSA doubling time (PSADT). The PSADT appears to be the most important predictor of development of distant metastasis and prostate cancer-specific mortality. At present, no data support a standard management approach for these patients, and clinical trials pose a major challenge in view of the methodologic complexities involved. Patients and treating physicians should make major efforts to participate in clinical trials in this patient population.

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Presenter : Sandy Srinivas

). 3 All patients enrolled in these trials had a PSA doubling time (PSADT) of ≤10 months and no evidence of metastatic disease on conventional imaging. “The 3 drugs [in these trials] have a similar mechanism of action but had different side

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Brandon A. Mahal, Ming-Hui Chen, Andrew A. Renshaw, Marian J. Loffredo, Philip W. Kantoff and Anthony V. D'Amico

recommend that patients with a short PSA doubling time (PSA-DT) and an otherwise long life expectancy be encouraged to consider earlier ADT. 2 , 12 – 15 However, an alternative hypothesis is that patients with favorable risk factors such as long PSA-DT and

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Simon D. Fung-Kee-Fung, Sima P. Porten, Maxwell V. Meng and Michael Kuettel

is the cutoff for reclassifying disease from low risk to higher risk, which triggers a recommendation to the patient to undergo some form of active treatment. The Toronto group reclassified patients as higher risk based on 3 criteria: PSA doubling

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Celestia S. Higano

A rapid PSA doubling time (PSADT) and/or Gleason score of 8 or higher are associated with poorer outcomes, and these patients should probably be offered immediate ADT or treatment on a clinical trial. Alternatively, those with a prolonged PSADT

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Matthew E. Nielsen, Bruce J. Trock and Patrick C. Walsh

was 1 year. The addition of hormonal therapy to salvage RT was not associated with a significant increase in PCSS, and the survival benefit of salvage RT was limited to men with a PSA doubling time (PSADT) of less than 6 months who underwent salvage RT

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James L. Mohler, Emmanuel S. Antonarakis, Andrew J. Armstrong, Anthony V. D’Amico, Brian J. Davis, Tanya Dorff, James A. Eastham, Charles A. Enke, Thomas A. Farrington, Celestia S. Higano, Eric Mark Horwitz, Michael Hurwitz, Joseph E. Ippolito, Christopher J. Kane, Michael R. Kuettel, Joshua M. Lang, Jesse McKenney, George Netto, David F. Penson, Elizabeth R. Plimack, Julio M. Pow-Sang, Thomas J. Pugh, Sylvia Richey, Mack Roach III, Stan Rosenfeld, Edward Schaeffer, Ahmad Shabsigh, Eric J. Small, Daniel E. Spratt, Sandy Srinivas, Jonathan Tward, Dorothy A. Shead and Deborah A. Freedman-Cass

prostate cancer. Those with a short PSA doubling time (PSADT) are at greatest risk of death. Not all PSA recurrences are clinically relevant; thus, PSADT may be a more useful measure of risk of death. 124 The NCCN Guidelines Panel recommends that NCCN risk