Prostate Cancer Relapse after Therapy with Curative Intention: A Diagnostic and Therapeutic Dilemma

Abstract

Prostate cancer is the most common malignant disease and second in causes of cancer death among men in Western Europe and North America. Despite improved surgical and irradiation techniques tumor relapse after curatively intended therapy is not uncommon. Due to the difficulty in discriminating local and systemic progression, it is often difficult to decide what this means for the patient and what kind of second-line treatment has to be given. Modern imaging techniques (MRI with endorectal coil, Choline-PET-CT, ProstaScint®-Scan) are used for diagnosis of prostate cancer relapse. Nevertheless, early detection of local tumor relapse and likewise the detection of disseminated tumor cells often fails. To differentiate between local and systemic progression, prognostic factors of the primary tumor (grading, surgical margins, infiltration of the seminal vesicles, lymph node metastases) and PSA kinetics are used. The time from initial treatment to biochemical relapse and PSA doubling time are of highest prognostic relevance. Local progression allows second-line local treatment with potentially curative results (local irradiation after radical prostatectomy, salvage-surgery / cryotherapy / HIFU after irradiation), while in the case of systemic progress a palliative systemic therapy (hormonal treatment, chemotherapy, bisphosphonates) is indicated. Before deciding on the most appropriate therapy, prognostic factors and the patient’s individual situation (co-morbidity, life expectancy, individual wishes) should be taken into account.

Presence of Symptom Distress and Prostate Cancer-Related Anxiety in Patients at the Beginning of Cancer Rehabilitation

“…Prostate cancer is one of the most prevalent male cancers in Germany and other developed countries, with an estimated annual incidence of 678,000 new cases worldwide [5]. Standard therapy includes radical prostatectomy and radiotherapy [6]. Remarkably, given the high incidence, studies on symptom distress and its impact on emotional well-being of patients have been relatively rare so far in comparison to research on other cancer types such as breast cancer.…”

Metastatic Prostate Cancer in an Asymptomatic Patient with an Initial Prostate-Specific Antigen (PSA) Serum Concentration of 21,380 ng/ml

“…RecentstudieshavedemonstratedthataserumPSAlevel ofgreaterthan100ng/mlyieldeda50-100%positivepredic-tivevalueforbonemetastasis [8][9][10][11].Toourknowledge,the …”

“…shown that, for groups of men with prostate cancer, serum PSAcorrelatesdirectlywithadvancedclinicalandpathologicalstage [8,9]. RecentstudieshavedemonstratedthataserumPSAlevel ofgreaterthan100ng/mlyieldeda50-100%positivepredic-tivevalueforbonemetastasis [8][9][10][11].Toourknowledge,the …”

Methods for the diagnosis and treatment of oligometastases in patients with prostate cancer and progressive disease after radical treatment

“…Помимо хирургического лечения у больных с прогрессированием РПЖ и единичными метастазами в ЛУ в настоящее время широко изучает-ся другой терапевтический подход. Как известно, ЛТ активно используют в лечении пациентов с РПЖ [32][33][34][35][36][37][38][39][40][41]. В последнее время все чаще применяют стерео-таксическую ЛТ.…”