Rising Prostate-Specific Antigen after Primary Treatment of Prostate Cancer: Sequential Hormone Manipulation

Abstract

Objective: To evaluate systematically the current endocrine treatment options for patients with biochemical recurrence after radical prostatectomy or radiation therapy for localized prostate cancer. Methods: Literature search of PubMed documented publications and abstracts from international meetings. Key items included timing and type of salvage hormone therapy, length of its application and handling of side effects. Results: The majority of patients with isolated prostate-specific antigen (PSA) relapse are not candidates for salvage treatment with curative intent. The PSA threshold that triggers initiation of hormonal therapy is debatable and should be based also on pretreatment risk assessment. Intermittent androgen suppression is an emerging concept to circumvent the unresolved controversy of early versus deferred endocrine therapy. Since the tumor load at time of recurrence is low, peripheral androgen blockade with an antiandrogen and a 5α-reductase inhibitor is an acceptable first choice. In case of progression, addition of a LHRH analogue would be the next step. Antiandrogen withdrawal and second-line antiandrogens are clinically of limited value. Conclusions: Biochemical-only progression after definitive treatment in curative intent is different from objective or even symptomatic relapse and allows for sequential hormonal therapy with a variety of compounds.

Clinical Profile, Quality of Care, and Recurrence in Arab-American and Caucasians Prostate Cancer Patients in Michigan

“…In about one-third of patients after radical prostatectomy there is a biochemical relapse with increasing prostate specific antigen (PSA) within 10 years [24]. However, most of these patients with a biochemical relapse are not candidates for salvage treatment with curative intent [25]. Among non-curative options, hormone therapy remains the first line of treatment [24] with peripheral androgen blockade—anti-androgen and a 5α-reductase inhibitor being the first choice [25].…”

Growth Hormone Inhibitors in Prostate Cancer: A Systematic Analysis

“…Due to the high incidence of rising PSA following unsuccessful local therapy with curative intent of prostate cancer, sequential hormonal manipulation plays an increasingly important role [3] . To enhance the longevity of the patients, secondary hormonal manipulations have to be employed.…”

“…5 ␣ -reductase inhibitor stops the conversion of testosterone to its active metabolite 5 ␣ -dihydrotestosterone and the binding to the androgen receptor (AR) [3] . As it does not interfere with the circulating testosterone levels and avoids the systemic side effects of hormonal intervention, this approach represents a promising investigational therapy for patients with prostate-specific antigen (PSA)-only disease.…”