Follow-up After Radical Treatments and Relapse

Chapter

Abstract

Relapse after curative treatment is not rare. It is defined as a PSA > 0.2 g/ml and increasing after surgery, or above nadir +2 ng/ml after radiotherapy. No consensus definition is available for the other modalities.

Any form of salvage treatment must be balanced by its natural history, the expected benefit (relapse-free, metastasis-free, or cancer-specific survival), and the individual overall life expectancy. Relapsing after surgery, if a postoperative radiotherapy is considered, it should be used as early as possible, especially when the PSA-DT is low (improved local control). For slow-growing PSA, its survival impact is unproven. The clinical benefit of salvage ADT is questionable except for a Gleason > 7 and/or PSA-DT < 12 months (metastasis-free survival benefit). No survival increase has been observed. The combination of ADT and external beam remain experimental.

Following radiotherapy, salvage surgery is a challenging procedure but an effective secondary treatment. It must be restricted to those with the highest probability of long-term cure: as early as possible at relapse, with a PSA <4 ng/ml, a PSA-DT >12 months, and a postradiotherapy Gleason score <8. Salvage brachytherapy, cryotherapy, or HIFU can only be considered as experimental. Systemic salvage modality after radiotherapy is based on ADT, even if convincing data are lacking. As for surgery, only those with a PSA-DT <12 months might benefit from early use. No survival benefit has been observed. IAD should be considered as the new standard.

Keywords

Radical Prostatectomy Androgen Deprivation Therapy Salvage Radiotherapy Positron Emission Tomography Choline Intermittent Androgen Deprivation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Urology departmentUniversity hospitalSt Etienne Cedex 2France

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