Management of patients with an increasing prostate-specific antigen after radical prostatectomy.
ABSTRACT Since the late 1980s, early detection and monitoring of men for prostate cancer by serum prostate-specific antigen (PSA) measurement has resulted in an increase in the number of men presenting with a potentially curable disease. During the same time, in an attempt to provide a definitive cure, radical prostatectomy has been performed increasingly and now is regarded as the management option of choice for many patients with clinically localized prostate cancer. Radical prostatectomy involves the removal of all of the prostate tissue resulting in the serum PSA level to steadily decline to an undetectable level within 4 to 6 weeks after surgery. Despite improvements in surgical technique and a marked downward stage shift brought about by serum PSA testing, approximately 25% of men ultimately will experience a subsequent increase in serum PSA to a detectable level indicating disease recurrence after radical prostatectomy within 15 years. In this brief review, the factors associated with a high risk for disease recurrence after radical prostatectomy are discussed. Factors indicating whether the increasing serum PSA is caused by local recurrence or metastatic disease and the management options available to address serum PSA recurrence also are discussed.
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ABSTRACT: IntroductionWe assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution.Actas urologicas españolas 01/2011; 35(4):201-207. · 1.14 Impact Factor
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ABSTRACT: We assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution. Retrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student's t-test to compare averages. With a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10 (p=0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p=0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501 for a Gleason score 8-10 (p=0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen (< 10%) was 649 days and 345 for Ki-67 positive (> 10%) (p=0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p=0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p=0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p=0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively. The Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA > 10 ng/ml and Ki-67 are independent factors.Actas urologicas españolas 03/2011; 35(4):201-7. · 1.14 Impact Factor
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ABSTRACT: The aim of this review is to provide a discussion of the diagnostic evaluation of biochemical recurrence following radical prostatectomy (RP) and an overview of the postoperative hormonal treatment (HT) options. As no randomized trials in the clinical setting of postoperative prostate-specific antigen recurrence have been reported, there is no conclusive evidence that HT after RP will prolong survival or reduce morbidity. Non-traditional approaches, such as intermittent androgen deprivation, non-steroidal anti-androgens and combination of finasteride and non-steroidal anti-androgen, are investigated and may be acceptable options. Combinations of HT with radiotherapy and/or chemotherapy for treatment of recurrent prostate cancer are under study.Prostate cancer and prostatic diseases 03/2009; 12(2):116-23. · 2.10 Impact Factor