Rising serum PSA after radiation therapy for localized prostate cancer: Salvage local therapy
- Judd W Moul, MD, FACS
Judd W Moul, MD, FACS
- James H. Semans, MD Professor of Surgery
- Division of Urologic Surgery
- Duke University Medical Center
- Director, Duke Prostate Center
- Duke Cancer Institute
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Prostate-specific antigen (PSA) is a sensitive and specific serum marker for prostate tissue. Serial measurements are routinely obtained to detect early disease recurrence in men who have received definitive treatment for localized disease.
The role of definitive salvage therapy after initial radiation therapy (RT [external beam or brachytherapy]) is reviewed here. Other aspects of patient management for men with a rising serum PSA following initial RT are discussed separately:
- Roach M 3rd, Hanks G, Thames H Jr, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65:965.
- Nguyen PL, D'Amico AV, Lee AK, Suh WW. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: a systematic review of the literature. Cancer 2007; 110:1417.
- Buyyounouski MK, Pickles T, Kestin LL, et al. Validating the interval to biochemical failure for the identification of potentially lethal prostate cancer. J Clin Oncol 2012; 30:1857.
- Zagars GK, Pollack A. Kinetics of serum prostate-specific antigen after external beam radiation for clinically localized prostate cancer. Radiother Oncol 1997; 44:213.
- Zelefsky MJ, Ben-Porat L, Scher HI, et al. Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer. J Clin Oncol 2005; 23:826.
- de la Taille A, Hayek O, Benson MC, et al. Salvage cryotherapy for recurrent prostate cancer after radiation therapy: the Columbia experience. Urology 2000; 55:79.
- Tiguert R, Rigaud J, Lacombe L, et al. Neoadjuvant hormone therapy before salvage radiotherapy for an increasing post-radical prostatectomy serum prostate specific antigen level. J Urol 2003; 170:447.
- Punnen S, Cooperberg MR, D'Amico AV, et al. Management of biochemical recurrence after primary treatment of prostate cancer: a systematic review of the literature. Eur Urol 2013; 64:905.
- Uchida T, Shoji S, Nakano M, et al. High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy. BJU Int 2011; 107:378.
- Chade DC, Eastham J, Graefen M, et al. Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol 2012; 61:961.
- Kaffenberger SD, Keegan KA, Bansal NK, et al. Salvage robotic assisted laparoscopic radical prostatectomy: a single institution, 5-year experience. J Urol 2013; 189:507.
- Chade DC, Shariat SF, Cronin AM, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol 2011; 60:205.
- Rocco B, Cozzi G, Spinelli MG, et al. Current status of salvage robot-assisted laparoscopic prostatectomy for radiorecurrent prostate cancer. Curr Urol Rep 2012; 13:195.
- Rogers E, Ohori M, Kassabian VS, et al. Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels. J Urol 1995; 153:104.
- Moul JW, Paulson DF. The role of radical surgery in the management of radiation recurrent and large volume prostate cancer. Cancer 1991; 68:1265.
- Lerner SE, Blute ML, Zincke H. Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer. J Urol 1995; 154:1103.
- Stephenson AJ, Scardino PT, Bianco FJ Jr, et al. Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy. J Urol 2004; 172:2239.
- Gotto GT, Yunis LH, Vora K, et al. Impact of prior prostate radiation on complications after radical prostatectomy. J Urol 2010; 184:136.
- Ward JF, Sebo TJ, Blute ML, Zincke H. Salvage surgery for radiorecurrent prostate cancer: contemporary outcomes. J Urol 2005; 173:1156.
- Gheiler EL, Tefilli MV, Tiguert R, et al. Predictors for maximal outcome in patients undergoing salvage surgery for radio-recurrent prostate cancer. Urology 1998; 51:789.
- Bianco FJ Jr, Scardino PT, Stephenson AJ, et al. Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62:448.
- Stephenson AJ, Eastham JA. Role of salvage radical prostatectomy for recurrent prostate cancer after radiation therapy. J Clin Oncol 2005; 23:8198.
- Masterson TA, Stephenson AJ, Scardino PT, Eastham JA. Recovery of erectile function after salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Urology 2005; 66:623.
- Garzotto M, Wajsman Z. Androgen deprivation with salvage surgery for radiorecurrent prostate cancer: results at 5-year followup. J Urol 1998; 159:950.
- Wenske S, Quarrier S, Katz AE. Salvage cryosurgery of the prostate for failure after primary radiotherapy or cryosurgery: long-term clinical, functional, and oncologic outcomes in a large cohort at a tertiary referral centre. Eur Urol 2013; 64:1.
- Pisters LL, Rewcastle JC, Donnelly BJ, et al. Salvage prostate cryoablation: initial results from the cryo on-line data registry. J Urol 2008; 180:559.
- Williams AK, Martínez CH, Lu C, et al. Disease-free survival following salvage cryotherapy for biopsy-proven radio-recurrent prostate cancer. Eur Urol 2011; 60:405.
- Siddiqui KM, Billia M, Al-Zahrani A, et al. Long-Term Oncologic Outcomes of Salvage Cryoablation for Radio-Recurrent Prostate Cancer. J Urol 2016; 196:1105.
- Perrotte P, Litwin MS, McGuire EJ, et al. Quality of life after salvage cryotherapy: the impact of treatment parameters. J Urol 1999; 162:398.
- Robinson JW, Donnelly BJ, Coupland K, et al. Quality of life 2 years after salvage cryosurgery for the treatment of local recurrence of prostate cancer after radiotherapy. Urol Oncol 2006; 24:472.
- Pisters LL, Leibovici D, Blute M, et al. Locally recurrent prostate cancer after initial radiation therapy: a comparison of salvage radical prostatectomy versus cryotherapy. J Urol 2009; 182:517.
- Babaian RJ, Donnelly B, Bahn D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol 2008; 180:1993.
- Ramey SJ, Marshall DT. Re-irradiation for salvage of prostate cancer failures after primary radiotherapy. World J Urol 2013; 31:1339.
- Grado GL, Collins JM, Kriegshauser JS, et al. Salvage brachytherapy for localized prostate cancer after radiotherapy failure. Urology 1999; 53:2.
- Aaronson DS, Yamasaki I, Gottschalk A, et al. Salvage permanent perineal radioactive-seed implantation for treating recurrence of localized prostate adenocarcinoma after external beam radiotherapy. BJU Int 2009; 104:600.
- Burri RJ, Stone NN, Unger P, Stock RG. Long-term outcome and toxicity of salvage brachytherapy for local failure after initial radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2010; 77:1338.
- Nguyen PL, Chen MH, D'Amico AV, et al. Magnetic resonance image-guided salvage brachytherapy after radiation in select men who initially presented with favorable-risk prostate cancer: a prospective phase 2 study. Cancer 2007; 110:1485.
- Lee HK, Adams MT, Motta J. Salvage prostate brachytherapy for localized prostate cancer failure after external beam radiation therapy. Brachytherapy 2008; 7:17.
- Chen CP, Weinberg V, Shinohara K, et al. Salvage HDR brachytherapy for recurrent prostate cancer after previous definitive radiation therapy: 5-year outcomes. Int J Radiat Oncol Biol Phys 2013; 86:324.
- Lee B, Shinohara K, Weinberg V, et al. Feasibility of high-dose-rate brachytherapy salvage for local prostate cancer recurrence after radiotherapy: the University of California-San Francisco experience. Int J Radiat Oncol Biol Phys 2007; 67:1106.
- GENERAL APPROACH
- DEFINITION OF BIOCHEMICAL FAILURE
- PATIENT SELECTION
- SALVAGE THERAPY
- Radical prostatectomy
- - Preoperative evaluation
- - Disease control
- - Complications
- - Perioperative ADT
- - Efficacy
- - Complications
- - Cryotherapy versus salvage prostatectomy
- SUBSEQUENT BIOCHEMICAL RECURRENCE
- SUMMARY AND RECOMMENDATIONS