Rising serum PSA after treatment for localized prostate cancer: Systemic 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
- Mary-Ellen Taplin, MD
Mary-Ellen Taplin, MD
- Associate Professor of Medicine
- Harvard Medical School
- 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. (See "Follow-up surveillance during and after treatment for prostate cancer".)
Monitoring PSA after definitive treatment of localized prostate cancer with either radiation therapy (RT) or radical prostatectomy leads to the identification of men with a PSA-only (biochemical) recurrence. In this situation, increases in serum PSA are not accompanied by signs, symptoms, or radiographic evidence of locally recurrent or disseminated disease. (See "Rising serum PSA following local therapy for prostate cancer: Definition, natural history, and risk stratification", section on 'Definition of biochemical progression'.)
For men in whom there is a significant likelihood that disease is confined to the prostatic bed, salvage therapy may result in prolonged disease-free survival [1,2]. (See "Rising serum PSA after radiation therapy for localized prostate cancer: Salvage local therapy" and "Rising or persistently elevated serum PSA following radical prostatectomy for prostate cancer: Management".)
However, systemic treatment may be indicated for some men when clinical and radiographic features suggest that disseminated disease is highly probable, and hence, salvage local therapy is not indicated. In others cases, systemic therapy may be useful in men when comorbidity or advanced age precludes aggressive local salvage therapy.
The role of systemic therapy in men with a PSA recurrence without evidence of disseminated disease will be reviewed here. The management of patients with disseminated prostate cancer is discussed separately. (See "Overview of the treatment of disseminated castration-sensitive prostate cancer".)
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- GENERAL APPROACH
- ANDROGEN DEPRIVATION THERAPY
- When to initiate ADT-based therapy
- Monotherapy versus combined androgen blockade
- Continuous versus intermittent androgen deprivation
- - Approach
- - Role
- COMBINED MODALITY APPROACHES INCORPORATING ADT
- ADT plus abiraterone
- ADT plus chemotherapy
- NONCASTRATING HORMONAL THERAPY
- Antiandrogen monotherapy
- 5-alpha reductase inhibitors
- OTHER APPROACHES
- SURVEILLANCE DURING TREATMENT
- SUMMARY AND RECOMMENDATIONS