PSA recurrence after radiation therapy is defined in several ways. The RTOG-ASTRO Phoenix Consensus Definition is a PSA increase by 2 ng/mL or more after the PSA
nadir, however, many clinicians do not wait for the Phoenix criteria to be achieved before evaluating recurrence. The NCCN guidelines suggest that a recurrence evaluation should be considered when PSA has been confirmed to be increasing after radiation even if the increase above nadir is not yet at 2 ng/mL, especially in candidates for salvage local therapy who are young and healthy. According to Dr. Feng, the management of a PSA recurrence after definitive radiation therapy includes the
initial workup (imaging with a potential biopsy), local therapy for local recurrences, local therapy for regional or distant recurrences, and systemic therapy. In this particular talk, Dr. Feng focused on the workup and treatment of local recurrences. The significance of a local recurrence after radiation therapy was recently evaluated by the MSKCC group and published in the Journal of Urology.1 In this study, 382 patients underwent a posttreatment biopsy after external beam radiotherapy for clinically localized prostate cancer. The prevalence of positive biopsy was 30%, the treatment effect was 22%, and a negative biopsy was 48%. Importantly, the 15-year PSA relapse rate associated with a negative biopsy was 34%, the treatment effect was 36%, and positive post-treatment biopsy was 79%. The risk of distant metastasis was 2.6-fold higher in patients with a positive biopsy and cause-specific mortality was twice as high in patients with a positive biopsy compared to those with negative biopsy/ treatment effect biopsy. Dr. Feng’s personal criteria for who is an ideal candidate for local therapy after radiation therapy failure are as follows:
In summary of the above, Dr. Feng highlighted his management of a PSA recurrence after definitive radiation therapy with the following algorithm: According to Dr. Feng, there is a “potpourri of options” for local therapy in this setting, including brachytherapy, salvage radical prostatectomy, HIFU, cryotherapy, and SBRT. He notes that almost all of the salvage therapies for post-radiation therapy local recurrence are retrospective in nature. Dr. Feng concluded his presentation with the following take-home messages:
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia Twitter: @zklaassen_md at the 2019 Advanced Prostate Cancer Consensus Conference (APCCC) #APCCC19, Aug 29 - 31, 2019 in Basel, Switzerland References:
How often does prostate cancer recur after radiation?For the majority of men, prostate cancer is treatable and curable and does not come back after initial treatment. However, about 25%–33% of men with prostate cancer will experience a recurrence of their cancer after surgery or radiation.
What is the life expectancy after prostate radiation?Life Expectancy After Prostate Cancer Radiation
Those treated with external-beam radiation therapy have a cure rate of 91.3% for high-risk prostate cancer and 95.5% for intermediate-risk prostate cancer. Additionally, the five-year survival rate of this treatment is 98.8% overall.
Can you have radiation twice for prostate cancer?Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
What are the signs of prostate cancer returning?Usually the first sign that your cancer is starting to return is a continuous rise in the level of prostate specific antigen (PSA) in your blood. The PSA test is a very effective way of checking how successful your treatment has been. It can't show for certain if prostate cancer has come back, or where it might be.
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