Outcomes following negative prostate biopsy for patients with persistent disease after radiotherapy for prostate cancer

Abstract

Purpose: When faced with biochemical recurrence after definitive radiotherapy for prostate cancer, clinicians must determine whether the recurrence is local or systemic. Post radiotherapy prostate biopsies to detect persistent local disease are difficult to interpret histopathologically and are subject to sampling error. Our study examines outcomes for patients with a negative prostate biopsy performed for rising prostate-specific antigen (PSA) levels after prostate radiation. Materials and Methods:We performed a retrospective review of 238 prostate cancer patients with a negative biopsy following definitive radiotherapy. Seventy-five of these patients had biochemical recurrence at the time of biopsy. A negative biopsy was defined as the absence of prostate cancer without radiation-treatment effect in the specimen. Results: Patients underwent biopsy at a mean of 41 months after the completion of radiation. They had a mean PSA of 6. Patients were followed for an average of 63 months. Thirty-two patients (43%) developed metastasis, and 11 (15%) died of prostate cancer despite a negative post-radiation biopsy. Five of nine patients (56%) with sequential biopsies had a positive second biopsy. Conclusions: Patients with PSA recurrence and a negative post-radiation biopsy have a high chance of persistent local disease, progression, and death from prostate cancer. Furthermore, an initial negative biopsy does not rule-out local recurrence. Patients with biochemical recurrence after radiotherapy for prostate cancer need to be evaluated earlier for local recurrence.

Detection of Recurrent Prostate Carcinoma withanti-1-Amino-3-18F-Fluorocyclobutane-1-Carboxylic Acid PET/CT and111In–Capromab Pendetide SPECT/CT

“…Even an increase in PSA level after prostatectomy does not necessarily equate with clinical failure ( 2,4 ). Yet, prostate biopsies-especially those performed after therapy-are subject to sampling error and may underestimate true-positive disease ( 7,8,33,52,53 ). Most of our patients underwent nonradical prostatectomy procedures in which an increase in PSA level may be due to prostatitis or benign hypertrophy.…”

Evaluation of Recurrent Disease after Radiation Therapy for Patients Considering Local Salvage Therapy: Past vs. Contemporary Management

“…A negative post-radiation biopsy in the presence of BCR and absence of metastasis on imaging should not provide complete reassurance and should warrant further monitoring or workup. Upon an assessment of 286 men with BCR after RT but negative post-radiation prostate biopsy, during a 66-month average follow-up period, 43% of the patients developed metastasis and 15% died of PCa [72]. Furthermore, these authors demonstrated that a negative biopsy did not rule out local recurrence, as 5 of the 9 patients who underwent a repeat biopsy had a positive repeat biopsy [72].…”

“…Upon an assessment of 286 men with BCR after RT but negative post-radiation prostate biopsy, during a 66-month average follow-up period, 43% of the patients developed metastasis and 15% died of PCa [72]. Furthermore, these authors demonstrated that a negative biopsy did not rule out local recurrence, as 5 of the 9 patients who underwent a repeat biopsy had a positive repeat biopsy [72]. One study suggested the possibility of avoiding the necessity of a biopsy when both mpMRI and PSMA PET are positive [39]; however, further studies are necessary before this can be routinely implemented in clinical practice.…”

Two-years Postradiotherapy Biopsies: Lessons from MRC RT01 Trial

“…There is controversy over the value of prostate biopsy after radiotherapy (RT) treatment for prostate cancer in predicting future survival and recurrence trends [1,2]. The inherent difficulties in interpreting postradiation prostate biopsies [3] and debate regarding the optimal time of performing those biopsies have contributed to the uncertainty [1,4].…”