Biochemical Relapse After Primary Treatment for Prostate Cancer: Studies on Natural History and Therapeutic Considerations

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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Correspondence: Mario Eisenberger, MD, Johns Hopkins Medical Institutions, 1650 Orleans Street, Blaustein/Bunting Cancer Research Building, Room 1M 51, Baltimore, MD 21231-1000. E-mail: eisenma@jhmi.edu
  • 1

    JemalAMurrayTSamuelsA. Cancer statistics, 2003. CA Cancer J Clin2003;53:526.

  • 2

    HanMPartinAWPiantadosiS. Era specific biochemical recurrence-free survival following radical prostatectomy for clinically localized prostate cancer. J Urol2001;166:416419.

    • Search Google Scholar
    • Export Citation
  • 3

    ZietmanALCoenJJDallowKC. The treatment of prostate cancer by conventional radiation therapy: an analysis of long-term outcome. Int J Radiat Oncol Biol Phys1995;32:287292.

    • Search Google Scholar
    • Export Citation
  • 4

    KubanDAThamesHDLevyLB. Long-term multi-institutional analysis of stage T1-T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys2003;57:915928.

    • Search Google Scholar
    • Export Citation
  • 5

    SylvesterJEBlaskoJCGrimmPD. Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys2003;57:944952.

    • Search Google Scholar
    • Export Citation
  • 6

    LotanYRoehrbornCG. Clearance rates of total prostate specific antigen (PSA) after radical prostatectomy in African-Americans and Caucasians.. Prostate Cancer Prostatic Dis2002;5:111114.

    • Search Google Scholar
    • Export Citation
  • 7

    HaeseAHulandEGraefenMHammererP. Ultrasensitive detection of prostate specific antigen in the follow up of 422 patients after radical prostatectomy. J Urol1999;161:12061211.

    • Search Google Scholar
    • Export Citation
  • 8

    WitherspoonLRLapeyrolerieT. Sensitive prostate specific antigen measurements identify men with long disease-free intervals and differentiate aggressive from indolent cancer recurrences within 2 years after radical prostatectomy. J Urol1997;157:13221328.

    • Search Google Scholar
    • Export Citation
  • 9

    StockRGStoneNNCesarettiJA. Prostate-specific antigen bounce after prostate seed implantation for localized prostate cancer: descriptions and implications. Int J Radiat Oncol Biol Phys2003;56:448453.

    • Search Google Scholar
    • Export Citation
  • 10

    HanlonALPinoverWHHorwitzEMHanksGE. Patterns and fate of PSA bouncing following 3D-CRT. Int J Radiat Oncol Biol Phys2001;50:845849.

  • 11

    RosserCJKubanDALevyLB. Prostate specific antigen bounce phenomenon after external beam radiation for clinically localized prostate cancer. J Urol2002;168:20012005.

    • Search Google Scholar
    • Export Citation
  • 12

    CritzFAWilliamsWHBentonJB. Prostate specific antigen bounce after radioactive seed implantation followed by external beam radiation for prostate cancer. J Urol2000;163:10851089.

    • Search Google Scholar
    • Export Citation
  • 13

    Consensus statement: guidelines for PSA following radiation therapy. American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys1997;37:10351041.

    • Search Google Scholar
    • Export Citation
  • 14

    PoundCRPartinAWEisenbergerMA. Natural history of progression after PSA elevation following radical prostatectomy. JAMA1999;281:15911597.

    • Search Google Scholar
    • Export Citation
  • 15

    EisenbergerMAPartinAWPoundC. Natural history of progression of patients with biochemical (PSA) relapse following radical prostatectomy (Abstr #1527). Update Proc Am Soc of Clin Oncol ASCO2003.

    • Search Google Scholar
    • Export Citation
  • 16

    D'AmicoAVCoteKLoffredoM. Determinants of prostate cancer specific survival following radiation therapy during the prostate specific antigen era. J Urol2003;170 (suppl):S42S46.

    • Search Google Scholar
    • Export Citation
  • 17

    D'AmicoAVMoulJWCarrollPR. Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst2003;95: 13761383.

    • Search Google Scholar
    • Export Citation
  • 18

    PatelADoreyFFranklinJdeKernionJB. Recurrence patterns after radical retropubic prostatectomy: clinical usefulness of prostate specific antigen doubling times and log slope prostate specific antigen. J Urol1997;158:14411445.

    • Search Google Scholar
    • Export Citation
  • 19

    ZagarsGKPollackA. Kinetics of serum prostate-specific antigen after external beam radiation for clinically localized prostate cancer. Radiother Oncol1997;44:213221.

    • Search Google Scholar
    • Export Citation
  • 20

    LeeWRHanksGEHanlonA. Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: clinical observations. J Clin Oncol1997;15:230238.

    • Search Google Scholar
    • Export Citation
  • 21

    D'AmicoAVCoteKLoffredoM. Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol2002;20:45674573.

    • Search Google Scholar
    • Export Citation
  • 22

    CherMLBiancoFJJrLamJS. Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy. J Urol1998;160:13871391.

    • Search Google Scholar
    • Export Citation
  • 23

    FreitasJEGilvydasRFerryJDGonzalezJA. The clinical utility of prostate-specific antigen and bone scintigraphy in prostate cancer follow-up. J Nucl Med1991;32:13871390.

    • Search Google Scholar
    • Export Citation
  • 24

    KaneCJAmlingCLJohnstonePA. Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy. Urology2003;61:607611.

    • Search Google Scholar
    • Export Citation
  • 25

    KahnDWilliamsRDSeldinDW. Radioimmunoscintigraphy with 111Indium labeled CYT-356 for the detection of occult prostate cancer recurrence. J Urol1994;152:14901495.

    • Search Google Scholar
    • Export Citation
  • 26

    HinkleGHBurgersJKNealCE. Multicenter radioimmunoscintigraphic evaluation of patients with prostate carcinoma using indium-111 capromab pendetide. Cancer1998;83:739747.

    • Search Google Scholar
    • Export Citation
  • 27

    KahnDWilliamsRDHasemanMK. Radioimmunoscintigraphy with In-111-labeled capromab pendetide predicts prostate cancer response to salvage radiotherapy after failed radical prostatectomy. J Clin Oncol1998;16:284289.

    • Search Google Scholar
    • Export Citation
  • 28

    ThomasCTBradshawPTPollockBH. Indium-111-capromab pendetide radioimmunoscintigraphy and prognosis for durable biochemical response to salvage radiation therapy in men after failed prostatectomy. J Clin Oncol2003;21:17151721.

    • Search Google Scholar
    • Export Citation
  • 29

    MohideenNFlaniganRJDillehayG. Role of Prostascint scan in the assessment of patients who undergo radiotherapy for biochemical failure after radical prostectomy for prostate cancer (Abstr). J Urol2002;167(suppl):174.

    • Search Google Scholar
    • Export Citation
  • 30

    LeventisAKShariatSFSlawinKM. Local recurrence after radical prostatectomy: correlation of US features with prostatic fossa biopsy findings. Radiology2001;219:432439.

    • Search Google Scholar
    • Export Citation
  • 31

    FosterLSJajodiaPFournierGS. The value of prostate-specific antigen and transrectal ultrasound guided biopsy in detecting prostatic fossa recurrences following radical prostatectomy. J Urol1993;149:10241028.

    • Search Google Scholar
    • Export Citation
  • 32

    SilvermanJMKrebsTL. MR imaging evaluation with a transrectal surface coil of local recurrence of prostatic cancer in men who have undergone radical prostatectomy. AJR Am J Roentgenol1997;168:379385.

    • Search Google Scholar
    • Export Citation
  • 33

    SeltzerMABarbaricZBelldegrunA. Comparison of helical computerized tomography, positron emission tomography and monoclonal antibody scans for evaluation of lymph node metastases in patients with prostate specific antigen relapse after treatment for localized prostate cancer. J Urol1999;162:13221328.

    • Search Google Scholar
    • Export Citation
  • 34

    HoferCLaubenbacherCBlockTBreulJ. Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for the detection of local recurrence after radical prostatectomy. Eur Urol1999;36:3135.

    • Search Google Scholar
    • Export Citation
  • 35

    PoundCRPartinAWEpsteinJI. Prostate-specific antigen after anatomic radical retropubic prostatectomy. Patterns of recurrence and cancer control. Urol Clin North Am1997;24:395406.

    • Search Google Scholar
    • Export Citation
  • 36

    LeventisAKShariatSFKattanMW. Prediction of response to salvage radiation therapy in patients with prostate cancer recurrence after radical prostatectomy. J Clin Oncol2001;19:10301039.

    • Search Google Scholar
    • Export Citation
  • 37

    SartorCIStrawdermanMHLinXH. Rate of PSA rise predicts metastatic versus local recurrence after definitive radiotherapy. Int J Radiat Oncol Biol Phys1997;38:941947.

    • Search Google Scholar
    • Export Citation
  • 38

    CoxJDGallagherMJHammondEH. Consensus statements on radiation therapy of prostate cancer: guidelines for prostate re-biopsy after radiation and for radiation therapy with rising prostate-specific antigen levels after radical prostatectomy. American Society for Therapeutic Radiology and Oncology Consensus Panel. J Clin Oncol1999;17:1155.

    • Search Google Scholar
    • Export Citation
  • 39

    CadedduJAPartinAWDeWeeseTLWalshPC. Long-term results of radiation therapy for prostate cancer recurrence following radical prostatectomy. J Urol1998;159:173177.

    • Search Google Scholar
    • Export Citation
  • 40

    MorrisMMDallowKCZietmanAL. Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys1997;38:731736.

    • Search Google Scholar
    • Export Citation
  • 41

    SchildSEBuskirkSJWongWW. The use of radiotherapy for patients with isolated elevation of serum prostate specific antigen following radical prostatectomy. J Urol1996;156:17251729.

    • Search Google Scholar
    • Export Citation
  • 42

    WuJJKingSCMontanaGS. The efficacy of postprostatectomy radiotherapy in patients with an isolated elevation of serum prostate-specific antigen. Int J Radiat Oncol Biol Phys1995;32:317323.

    • Search Google Scholar
    • Export Citation
  • 43

    KatzMSZelefskyMJVenkatramanES. Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer. J Clin Oncol2003;21:483489.

    • Search Google Scholar
    • Export Citation
  • 44

    CattonCGospodarowiczMWardeP. Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol2001;59:5160.

    • Search Google Scholar
    • Export Citation
  • 45

    GargMKTekyi-MensahSBoltonS. Impact of postprostatectomy prostate-specific antigen nadir on outcomes following salvage radiotherapy. Urology1998;51:9981002.

    • Search Google Scholar
    • Export Citation
  • 46

    ZelefskyMJAschkenasyEKelsenS. Tolerance and early outcome results of postprostatectomy three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys1997;39:327333.

    • Search Google Scholar
    • Export Citation
  • 47

    CraneCHRichTAReadPW. Preirradiation PSA predicts biochemical disease-free survival in patients treated with postprostatectomy external beam irradiation. Int J Radiat Oncol Biol Phys1997;39:681686.

    • Search Google Scholar
    • Export Citation
  • 48

    StephensonAJShariatSFKattanMW. Predicting the outcome of salvage radiotherapy for suspected local recurrence of prostate cancer after radical prostatectomy (Abstr #1577). Proc Am Soc Clin Oncol2003;22:392.

    • Search Google Scholar
    • Export Citation
  • 49

    RogersEOhoriMKassabianVS. Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels. J Urol1995;153:104110.

    • Search Google Scholar
    • Export Citation
  • 50

    GheilerELTefilliMVTiguertR. Predictors for maximal outcome in patients undergoing salvage surgery for radio-recurrent prostate cancer. Urology1998;51:789795.

    • Search Google Scholar
    • Export Citation
  • 51

    LernerSEBluteMLZinckeH. Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer. J Urol1995;154:11031109.

    • Search Google Scholar
    • Export Citation
  • 52

    BrennerPCRussoPWoodDPMorseMJ. Salvage radical prostatectomy in the management of locally recurrent prostate cancer after 125I implantation. Br J Urol1995;75:4447.

    • Search Google Scholar
    • Export Citation
  • 53

    LosaANavaLDDi MuzioN: Salvage brachytherapy for local recurrence after radical prostatectomy and subsequent external beam radiotherapy. Urology2003;62:10681072.

    • Search Google Scholar
    • Export Citation
  • 54

    GradoGLCollinsJMKriegshauserJS. Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology1999;53:210.

  • 55

    IzawaJIMadsenLTScottSM: Salvage cryotherapy for recurrent prostate cancer after radiotherapy: variables affecting patient outcome. J Clin Oncol2002;20:26642671.

    • Search Google Scholar
    • Export Citation
  • 56

    ChinJLPautlerSEMouravievV. Results of salvage cryoablation of the prostate after radiation: identifying predictors of treatment failure and complications. J Urol2001;165:19371941.

    • Search Google Scholar
    • Export Citation
  • 57

    TunnUWEckartOOffenbachDE. Can intermittent androgen deprivation be an alternative to continuous androgen withdrawal in patients with PSA relapse? First results of the randomized prospective phase III clinical trial EC 507 (Abstr #1481). J Urol2003;169.

    • Search Google Scholar
    • Export Citation
  • 58

    TyrrellCJKaisarryAVIversenP. A randomized comparison of bicalutamide 150mg monotherapy versus castration in the treatment of metastatic and locally advanced prostate cancer. Eur Urol1998;33:447456.

    • Search Google Scholar
    • Export Citation
  • 59

    IversenPTyrrellCJKaisaryAV. Bicalutamide 150mg monotherapy compared with castration in patients with non-metastatic, locally advanced prostate cancer. J Urol2000;164:15791582.

    • Search Google Scholar
    • Export Citation
  • 60

    SeeWAWirthMPMcLeodDG. Bicalutamide as immediate therapy either alone or as adjuvant to standard care of patients with localized or locally advanced prostate cancer: first analysis of the early prostate cancer program. J Urol2002;168:429435.

    • Search Google Scholar
    • Export Citation
  • 61

    EisenbergerMABlumensteinBACrawfordED. Bilateral orchiectomy with or without flutamide for metastatic prostate cancer. N Engl J Med1998;339:10361042.

    • Search Google Scholar
    • Export Citation
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