An Algorithm For Managing The Failure Of External Bam Radiotherapy In Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Radiology / Nuclear Medicine;  Urology / Nephrology;  Men's health
Article Date: 12 Aug 2007 - 0:00 PDT

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UroToday.com- Dr. Dudderidge and colleagues at the University College London, England propose in the online version of BJU International an algorithm to manage prostate cancer (CaP) recurrence following radiotherapy (XRT).

This report is based upon the authors' review of relevant literature and their personal experience. They propose a surveillance plan for patients who underwent XRT for CaP with curative intent. An initial PSA at 6 weeks then every 3 months until a stable PSA nadir is reached. At that point PSA should be followed every 6 months. If the PSA begins to raise it should be followed again at 3 monthly intervals but if not then beginning at 5 years it can be checked annually.

They advocate the Phoenix definition of PSA failure, which is the PSA nadir plus 2ng/ml. In those with recurrence and contemplating salvage therapy a prostate biopsy should be performed. Staging should be performed using contrast enhanced dynamic MRI of the prostate. The authors reviewed the Prostascint scan but based upon their interpretation of the literature did not favor it.

For high risk cases (PSA >10ng/ml, Gleason score >7, PSADT <1 year) laparoscopic pelvic lymphadenectomy and bone scan are performed to evaluate for metastatic disease. Risk assessment is defined as follows; low risk is PSA<5ng/ml, Gleason score <6, stage 1 year. Moderate risk is PSA>5ng/ml, Gleason score >7 and who do not otherwise qualify as high risk and high risk is 2 of; PSA>10ng/ml, Gleason score >8, and PSADT <10 months.

Following risk assessment the patient should undergo counseling of all options. Active treatment options include delayed androgen deprivation therapy, salvage radical prostatectomy, salvage prostate cryotherapy, salvage brachytherapy, and salvage high intensity focused ultrasound.

Dudderidge T, Payne H and Emberton M
BJU Int. ePub, June 15, 2007
doi:10.1111/j.1464-410X.2007.06999.x

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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