Diagnostic evaluation of PSA recurrence and review of hormonal management after radical prostatectomy

Abstract

The aim of this review is to provide a discussion of the diagnostic evaluation of biochemical recurrence following radical prostatectomy (RP) and an overview of the postoperative hormonal treatment (HT) options. As no randomized trials in the clinical setting of postoperative prostatespecific antigen recurrence have been reported, there is no conclusive evidence that HT after RP will prolong survival or reduce morbidity. Non-traditional approaches, such as intermittent androgen deprivation, non-steroidal anti-androgens and combination of finasteride and nonsteroidal anti-androgen, are investigated and may be acceptable options. Combinations of HT with radiotherapy and/or chemotherapy for treatment of recurrent prostate cancer are under study.

Chemically modified non-antimicrobial tetracyclines are multifunctional drugs against advanced cancers☆

“…The biochemical recurrence is ≥34% within five years after initial diagnosis and 46% after 10 years; thus prostate cancers progress slowly. Regardless of the low rate of recurrence, prostate cancer causes substantial morbidity and pain in patients who have failed treatment for recurrent disease, including hormonal therapy (total depletion of androgen by chemical means), local radiation or both [8]. The main source of pain, debilitation and ultimate death is metastasis of the disease to bone (lumbar, vertebral and even metastasis to skull) [9, 10].…”

KLK5 gene expression is severely upregulated in androgen-independent prostate cancer cells after treatment with the chemotherapeutic agents docetaxel and mitoxantrone

“…No chemotherapeutic compound has ever been approved or rejected, for HRPC treatment, strictly on the basis that leads to PSA modulations. As a result, a great number of prospective studies are in progress investigating the role of PSA or other promising biomarkers in monitoring prostate cancer patients' treatment response (Fleming et al, 2006;Revelos et al, 2007;Van Poppel et al, 2009). …”

“…PSA (KLK3) apart from diagnostic purposes is also currently used for monitoring CaP patients' response to treatment (Reynolds et al, 2007). Nevertheless, PSA measurements cannot account for all the treatment effects observed (Fleming et al, 2006;Van Poppel et al, 2009). As a result, it is important to indentify novel tumor markers with greater efficacy, which can also be used, in combination with PSA kinetics, to achieve better treatment monitoring of CaP.…”