Management of prostate-specific antigen relapse in prostate cancer: A European consensus

Abstract

A European Consensus on the management of prostate-specific antigen (PSA) relapse in patients with prostate cancer has been formulated. The key recommendations proposed are that total PSA is the best detection tool for prostate cancer, with free and complexed PSA having a role in the PSA range 1-4 ng/ml. PSA relapse after radical prostatectomy (RP) has been defined as a value of 0.2 ng/ml with one subsequent rise, while the ASTRO definition should be used after radiotherapy. A PSA level of less than 0.4 ng/ml after hormonal therapy can be considered an indicator of a positive response. Continuous assessment using nomograms or artificial neural networks will help to determine whether progression after local therapy is distant or local, which is the basis for treatment decisions. Secondary treatment after local failure of RP should be initiated when PSA levels reach 1.0-1.5 ng/ml and salvage radiotherapy can be considered with or without hormonal therapy. Local failure after radiotherapy can be treated with a choice of high-intensity-focused ultrasound, salvage RP (only in highly selected patients), cryotherapy or external beam radiation. Treatment of distant failure involves hormonal manipulation, the type and the timing of which is based on both physician and patient preferences.

Management of Biochemical Recurrence After Primary Treatment of Prostate Cancer: A Systematic Review of the Literature

“…In 2007, the American Urological Association Prostate Guideline Update Panel reviewed 53 different definitions of BCR after RP and recommended using a serum PSA level >0.2 ng/ml, with a second confirmatory level above 0.2 ng/ml to define recurrence [12]. This recommendation is similar to the definition proposed by a European Consensus committee in 2004 [13].…”

Epithelial-to-Mesenchymal Transition Mediates Docetaxel Resistance and High Risk of Relapse in Prostate Cancer

“…Median follow-up time was 82 months (range, 10-135). PSA relapse was defined as two consecutive values of 0.2 ng/mL or greater (19). Radiologic progression was defined as the progression in soft tissue lesions measured by computed tomography or MRI, or by progression to bone (20).…”

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

“…One of commonly used definitions has been PSA ≥0.2 ng/mL with one subsequent rise. The American Urological Association and the European Association of Urology put forward a guideline that recommended PSA ≥0.2 ng/mL with a second confirmatory level of ＞0.2 ng/mL as the definition of PSA relapse (13)(14)(15). Freeland suggested PSA ＞0.2 ng/mL as an appropriate cut-off for PSA relapse, and reported that the likelihood of further PSA progression was 86% at 1 year and 100% at 3 years, when a post-operative PSA was ＞0.2 ng/mL (12).…”