Variation in the Definition of Biochemical Recurrence in Patients Treated for Localized Prostate Cancer: The American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel Report and Recommendations for a Standard in the Reporting of Surgical Outcomes

Abstract

A high degree of variability in the definition of biochemical recurrence exists following treatment for localized prostate cancer. Strict definitions for biochemical recurrence are necessary to identify men at risk for disease progression and to allow meaningful comparisons among patients treated similarly. The Panel acknowledges the American Society for Therapeutic Radiology and Oncology criteria and future modifications thereof for those receiving radiation therapy and recommends the newly developed American Urological Association criteria for those treated with radical prostatectomy. The purpose for the establishment of this standard is for data reporting purposes and for comparison of similarly treated patients. It is not intended to represent a threshold value for which to initiate treatment. The Panel acknowledges that the clinical decision to initiate treatment will be dependent on multiple factors including patient and physician interaction rather than a specific prostate specific antigen threshold value.

Spurious elevation of serum PSA after curative treatment for prostate cancer: clinical consequences and the role of heterophilic antibodies

“…Although this is not always the case, as evidenced by prior reports, it confirms the value of the current recommendations for the definition of postprostatectomy biochemical recurrence, two successive PSA values X0.2 ng ml À1 . 31 If it had been determined Spurious elevation of serum PSA CB Anderson et al that any of our patients had 'biochemical recurrent' cancer based on a single elevated PSA, several patients could have been unnecessarily treated with salvage therapy. Fortunately, in each case, the surgeons correctly verified elevated PSA tests in post-prostatectomy patients and either diagnosed biochemical recurrence or identified a falsely elevated lab value.…”

Low serum testosterone is associated with tumor aggressiveness and poor prognosis in prostate cancer

“…Disease progression in patients with localized tumors was defined as the presence of biochemical recurrence (BCR), local recurrence or distant metastasis (whichever was recorded first), as local recurrence or distant metastasis may occur with no record of an increase in PSA in certain cases. According to the American Urological Association Prostate Cancer Guidelines Panel (29), BCR in patients treated with radical prostatectomy is defined as a PSA ≥0.2 ng/ml with a second confirmatory level of PSA >0.2 ng/ml. The Radiation Therapy Oncology Group-American Society for Therapeutic Radiology and Oncology (30) defines BCR in patients with PCa who received radiotherapy as a rise in PSA of ≥2 ng/ml above the lowest level following treatment (the nadir).…”

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

“…For this reason, the European Consensus Group recommended that an ultrasensitive assay be used in monitoring for PCa recurrence but not for treatment decision making [11]. 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].…”