Defining Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy: A Proposal for a Standardized Definition

Abstract

BCR defined as a PSA value of at least 0.4 ng/mL followed by another increase best explains the development of distant metastasis among 10 candidate definitions, after controlling for clinical variables and the use of secondary therapy. On the basis of this evidence, we propose that this definition be adopted as the standard for reporting the outcome of RP.

Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges

“…Stephenson examined a PSA relapse definition that would best predict the development of metastatic disease among 10 definitions selected on the basis of acceptable sensitivity. PSA ≥0.4 ng/mL with one subsequent rise was the best predictor for clinical progression, and was associated with a high probability of subsequent PSA progression and the need for subsequent secondary therapy (16). Amling reported that the probability of subsequent PSA progression increased as a PSA cut-off value increased from 0.2 to 0.4 ng/mL, and recommended PSA ≥0.4 ng/mL for the definition of PSA relapse (10).…”

The Epstein Criteria Predict for Organ-Confined But Not Insignificant Disease and a High Likelihood of Cure at Radical Prostatectomy

“…The total number of cores obtained ranged from 6-34 (interquartile range: [10][11][12][13][14], and only 47 patients (17.5%) had fewer than 10 cores.…”

“…By correlating biopsy findings with pathologic features on RP specimens, we tested the ability of the Epstein criteria to predict three pathologic rising [10]. The classical end point of insignificant disease was chosen as a study end point based on the prior observations of Stamey et al [11] and Epstein et al [5]; the more liberal definition was included based on observations that the vast majority of pathologically proven Gleason 6 disease is organ confined regardless of tumor volume [12,13] Organ-confined disease was chosen as an end point based on a previous report of a high positive predictive value (PPV) of the Epstein criteria for this outcomes and its surrogacy for a high likelihood of cure for Gleason 6 and 7 tumors [14,15].…”

Comparative analysis of multiparametric magnetic resonance and PET-CT in the management of local recurrence after radical prostatectomy for prostate cancer

“…Treatment failure after RP is defined as a rising PSA level, in particular two consecutive values of PSA > 0.2 ng/ml appear to represent biochemical recurrent cancer [7][8][9][10]. Once PSA relapse has been diagnosed, it is of major importance to determine whether the recurrence has developed at local or at distant sites.…”