The Natural History and Predictors of Outcome Following Biochemical Relapse in the Dose Escalation Era for Prostate Cancer Patients Undergoing Definitive External Beam Radiotherapy

Zumsteg, Zachary S.; Spratt, Daniel E.; Romesser, Paul B.; Pei, Xin; Zhang, Zhigang; Polkinghorn, William R.; McBride, Sean; Kollmeier, Marisa A.; Yamada, Yoshiya; Zeléfsky, Michael J.

doi:10.1016/j.eururo.2014.09.028

Cited by 168 publications

(129 citation statements)

References 29 publications

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“…After definitive RT, factors that signal a high risk of metastases and PCa-specific mortality are similar to those after RP: a PSA-DT of <3 months, clinical stage cT3b–T4, biopsy Gleason score 8–10, or BCR within 3 years of RT [1, 30-32]. An analogous area of uncertainty for risk stratification also exists for recurrence after RT; in this case, when the patient’s PSA-DT is between 3 and 15 months [1].…”

Section: The Natural History Of Bcrmentioning

confidence: 99%

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

et al. 2017

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How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Importantly, this prostate-specific antigen (PSA)-only recurrence is a surrogate neither of PCa-specific survival nor of overall survival. Physicians are therefore challenged with preventing or delaying the onset of clinical progression in those deemed at risk, while avoiding over-treating patients whose disease may never progress beyond PSA-only recurrence. Adjuvant therapy for radical prostatectomy (RP) or local radiotherapy (RT) has a role in certain at-risk patients, although it is not recommended in low-risk PCa owing to the significant side-effects associated with RT and androgen deprivation therapy (ADT). The recommendations for salvage therapy differ depending on whether BCR occurs after RP or primary RT, and in either case, definitive evidence regarding the best strategy is lacking. Options for treatment of BCR after RP are RT at least to the prostatic bed, complete or intermittent ADT, or observation; for BCR after RT, salvage RP, cryotherapy, complete or intermittent ADT, brachytherapy, high-intensity focused ultrasound (HIFU), or observation can be considered. Many patient- and cancer-specific factors need to be taken into account when deciding on the best strategy, and optimal management depends on the involvement of a multidisciplinary team, consultation with the patient themselves, and the adoption of an individualised approach. Improvements in imaging techniques may enable earlier detection of metastases, which will hopefully refine future management decisions.

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Section: The Natural History Of Bcrmentioning

confidence: 99%

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

et al. 2017

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“…A few series have defined pre-salvage PSA, PSA-doubling time (PSADT) and time-to-relapse after primary therapy as possible predictors of biochemical failure after salvage brachytherapy [11][12][13] . Although biochemical failure often precedes the development of distant metastases and death 1 , no predictive factors for survival have as of yet been identified. In this report, we therefore aimed to develop a prognostic model for PCa-specific survival (PCaSS) and overall survival (OS) after whole-gland salvage 125-brachytherapy, based on the largest salvage I-125-brachytherapy cohort.…”

Section: Introductionmentioning

confidence: 99%

“…EBRT dose escalation has led to further improvement of these results 1,3 . However, depending on tumour characteristics, PSA-parameters and use of androgen deprivation therapy (ADT), biochemical recurrences can still occur in 30-50% of patients after 5-10-years 1,3 . Over 80% of patients can harbour a prostate-only recurrence 4 .…”

Section: Introductionmentioning

confidence: 99%

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Multivariable model development and internal validation for prostate cancer specific survival and overall survival after whole-gland salvage Iodine-125 prostate brachytherapy

Peters

Zyp

Moerland

et al. 2016

Radiotherapy and Oncology

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Background: Whole-gland salvage Iodine-125-brachytherapy is a potentially curative treatment strategy for localised prostate cancer (PCa) recurrences after radiotherapy. Prognostic factors influencing PCa-specific and overall survival (PCaSS & OS) are not known. The objective of this study was to develop a multivariable, internally validated prognostic model for survival after whole-gland salvage I-125-brachytherapy.

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“…Primary definitive therapy options for PCa remain radiation therapy (RT) and radical prostatectomy (RP), which are used with curative intent, although both methods have improved over time. Despite the high success rates in primary treatment, 15-25% of patients still experience biochemical recurrence (BCR), following primary definitive therapy with RP or RT [2][3][4][5][6][7]. The definition of BCR varies between therapy methods.…”

Section: Introductionmentioning

confidence: 99%

PET Imaging of Recurrent and Metastatic Prostate Cancer with Novel Tracers

et al. 2016

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Early detection of recurrent prostate cancer (PCa) is of paramount importance to deliver prompt and accurate therapy reducing the chance of progression to metastatic disease. However, current imaging modalities such as conventional computed tomography, MRI and PET scanning do not provide sufficient sensitivity, especially at lower prostate-specific antigen values. Moreover, biological characterization of PCa has become increasingly important to provide patient-specific therapy and current imaging poorly characterizes disease aggressiveness. The current uprise of novel PET tracers in recurrent and metastatic PCa shows promising, yet variable sensitivities and specificities in detection, indicating the need for further studies. In this review, we highlight current and new PET tracers that have been developed to improve the detection of recurrent and metastatic PCa. KEYWORDS• biochemical recurrenceProstate cancer (PCa) is the most common noncutaneous malignancy in American men with 180,890 new cases and 26,120 deaths estimated in 2016 alone [1]. Recent advances in detection, monitoring and treatment of the disease include the growing use of multiparametric MRI, transrectal ultrasound/fusion MRI-guided biopsies and new focal therapies. Primary definitive therapy options for PCa remain radiation therapy (RT) and radical prostatectomy (RP), which are used with curative intent, although both methods have improved over time. Despite the high success rates in primary treatment, 15-25% of patients still experience biochemical recurrence (BCR), following primary definitive therapy with RP or RT [2][3][4][5][6][7]. The definition of BCR varies between therapy methods. For instance, following RP a rising PSA above 0.2 ng/ml defines BCR whereas following RT BCR is defined as a PSA change of 2.0 ng/ml above the nadir following RT and is known as the Phoenix criteria [7]. As rising PSA in post primary therapy patients is an indicator of PCa BCR, close monitoring of serum PSA levels following treatment is critical [7,8]. In the case of BCR, early detection and initiation of therapy is a key to better long-term outcomes. Early intervention is associated with a lower rate of metastatic disease. Thus, accurate and early detection of recurrence leading to earlier treatment will aid in hindering the progression of BCR to metastatic disease.Multiple imaging modalities exist for the detection of recurrent PCa including computed tomography (CT), bone scintigraphy, MRI and PET. However, the need for more sensitive and specific imaging modalities to detect early recurrent and metastatic PCa has been prompted by evidence supporting early treatment. In addition to more sensitive and specific imaging, there has been a 'thrust' toward personalized and targeted management to discover disease phenotype and predict clinical outcomes earlier, which PET/CT has answered the call [9]. The future demands more For reprint orders, please contact: reprints@futuremedicine.com

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The Natural History and Predictors of Outcome Following Biochemical Relapse in the Dose Escalation Era for Prostate Cancer Patients Undergoing Definitive External Beam Radiotherapy

Cited by 168 publications

References 29 publications

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

Multivariable model development and internal validation for prostate cancer specific survival and overall survival after whole-gland salvage Iodine-125 prostate brachytherapy

PET Imaging of Recurrent and Metastatic Prostate Cancer with Novel Tracers

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