Biochemical recurrence after radical prostatectomy: Current status of its use as a treatment endpoint and early management strategies

McCormick, Barrett Z.; Mahmoud, Alì Mokhtar; Williams, Stephen B.; Davis, John W.

doi:10.4103/iju.iju_355_18

Cited by 27 publications

(3 citation statements)

References 102 publications

(124 reference statements)

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“…There is still limited evidence and controversy regarding the correct timing and treatment in patients with PSA-only recurrence after RP (Table 2). Salvage radiotherapy and ADT are the treatment modalities accepted by current guidelines, while other options, such as salvage pelvic lymph node dissection (sPLND) in the event of nodal recurrence, are still awaiting validation [32]. Salvage RT (SRT) has been shown to decrease the onset of distant metastasis and improve PC-specific mortality, providing a possibility of cure in patients with increased PSA after RP.…”

Section: Bcr After Rpmentioning

confidence: 99%

How the Management of Biochemical Recurrence in Prostate Cancer Will Be Modified by the Concept of Anticipation and Incrementation of Therapy

Sciarra,

Santarelli,

Salciccia

et al. 2024

Cancers

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Biochemical recurrence (BCR) after primary treatments for prostate cancer (PC) is an extremely heterogeneous phase and at least a stratification into low- and high-risk cases for early progression in metastatic disease is necessary. At present, PSA-DT represents the best parameter to define low- and high-risk BCR PC, but real precision medicine is strongly suggested to define tailored management for patients with BCR. Before defining management, it is necessary to exclude the presence of low-volume metastasis associated with PSA progression using new-generation imaging, preferably with PSMA PET/CT. Low-risk BCR cases should be actively observed without early systemic therapies. Early treatment of low-risk BCR with continuous androgen deprivation therapy (ADT) can produce disadvantages such as the development of castration resistance before the appearance of metastases (non-metastatic castration-resistant PC). Patients with high-risk BCR benefit from early systemic therapy. Even with overall survival (OS) as the primary treatment endpoint, metastasis-free survival (MFS) should be used as a surrogate endpoint in clinical trials, especially in long survival stages of the disease. The EMBARK study has greatly influenced the management of high-risk BCR, by introducing the concept of anticipation and intensification through the use of androgen receptor signaling inhibitors (ARSIs) and ADT combination therapy. In high-risk (PSA-DT ≤ 9 months) BCR cases, the combination of enzalutamide with leuprolide significantly improves MFS when compared to leuprolide alone, maintaining an unchanged quality of life in the asymptomatic phase of the disease. The possibility of using ARSIs alone in this early disease setting is suggested by the EMBARK study (arm with enzalutamide alone) with less evidence than with the intensification of the combination therapy. Continued use versus discontinuation of enzalutamide plus leuprolide intensified therapy upon reaching undetectable PSA levels needs to be better defined with further analysis. Real-world analysis must verify the significant results obtained in the context of a phase 3 study.

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Section: Bcr After Rpmentioning

confidence: 99%

How the Management of Biochemical Recurrence in Prostate Cancer Will Be Modified by the Concept of Anticipation and Incrementation of Therapy

Sciarra,

Santarelli,

Salciccia

et al. 2024

Cancers

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“…The median follow-up was 5.5 years and the minimum follow-up was 5 years. We set the minimum follow-up at 5 years, as most patients show a PSA BCR the rst 5 years after surgery (23,24).…”

Section: Patient Populationmentioning

confidence: 99%

Anti-Müllerian Hormone: a novel biomarker for aggressive prostate cancer? Emerging evidence from a prospective study of radical prostatectomies

Kontogiannis

Markantes

Stamou

et al. 2023

Preprint

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PURPOSE Prostate cancer patients are a heterogeneous group concerning the aggressiveness of the disease. The relationship of steroid hormones with the aggressiveness of prostate cancer is unclear. It is known that the Anti-Müllerian Hormone (AMH), inhibits prostate cancer cell lines in vitro. The aim of this study is to investigate the relationship of AMH and steroid hormones with the aggressiveness of prostate cancer.METHODS This was a prospective study of consecutive radical prostatectomy patients. We measured the following hormones: total testosterone, sex hormone binding globulin, albumin, luteinizing hormone, follicle stimulating hormone, estradiol, dehydroepiandrosterone sulfate, androstenedione and AMH. The minimum follow-up after radical prostatectomy was 5 years. For the aggressiveness of prostate cancer, we considered the following 3 variables: post-operative Gleason Score (GS) ≥ 8, TNM pΤ3 disease and PSA biochemical recurrence (BCR).RESULTS In total, 91 patients were enrolled. The mean age and PSA was 64.8 years and 9.3 ng/dl, respectively. The median post-operative GS was 7. Low AMH blood levels were correlated with higher post-operative GS (p = 0.001), as well as with PSA BCR (p = 0.043). With pT3 disease, only albumin was (negatively) correlated (p = 0.008). ROC analysis showed that AMH is a good predictor of BCR (AUC 0.646, 95% CI 0.510–0.782, p = 0.043); a cut-off value of 3.06 ng/dl had a positive prognostic value of 71.4% and negative prognostic value of 63.3% for BCR. Cox regression analysis showed that AMH is a statistically significant and independent prognostic marker for BCR (p = 0.013). More precisely, for every 1 ng/ml of AMH rise, the probability for PSA BCR decreases by 20.8% (HR = 0.792). Moreover, in Kaplan-Meier analysis, disease-free survival is more probable in patients with AMΗ ≥ 3.06 ng/ml (p = 0.004).CONCLUSIONS Low AMH blood levels were correlated with aggressive prostate cancer in this radical prostatectomy cohort of patients. Therefore, AMH could be a prognostic biomarker for the aggressiveness of the disease.

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“…On the other hand, metastatic prostate cancer presents a stark contrast with a 31% survival rate [ 4 ]. However, despite the relatively successful management of localized prostate cancer through surgery, such as radical prostatectomy, a considerable proportion of patients, ranging from 20% to 40%, experience biochemical recurrence (BCR) [ 5 ], characterized by an increase in serum prostate-specific antigen (PSA) [ 6 ]. Furthermore, a significant proportion of BCR tumors are likely to progress to metastatic prostate cancers, which significantly contribute to prostate cancer-related deaths.…”

Section: Introductionmentioning

confidence: 99%

Predicting prostate cancer recurrence: Introducing PCRPS, an advanced online web server

He,

Hu,

Wang

et al. 2024

Heliyon

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Biochemical recurrence after radical prostatectomy: Current status of its use as a treatment endpoint and early management strategies

Cited by 27 publications

References 102 publications

How the Management of Biochemical Recurrence in Prostate Cancer Will Be Modified by the Concept of Anticipation and Incrementation of Therapy

How the Management of Biochemical Recurrence in Prostate Cancer Will Be Modified by the Concept of Anticipation and Incrementation of Therapy

Anti-Müllerian Hormone: a novel biomarker for aggressive prostate cancer? Emerging evidence from a prospective study of radical prostatectomies

Predicting prostate cancer recurrence: Introducing PCRPS, an advanced online web server

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