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KMID : 1001020110090030104
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Korean Journal of Urological Oncology
2011 Volume.9 No. 3 p.104 ~ p.111
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Definition of BCR and Further Evaluation
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Song Sang-Hoon
Kwak Cheol
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Abstract
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The aim of this review is to provide a discussion of the diagnostic evaluation of biochemicalrecurrence following radical prostatectomy(RP) and radiotherapy(RT). Life-long periodic PSA testing for biochemical recurrence is standard of care;however, there is no single definition of biochemicalrecurrence that reliably predicts clinical recurrence. It is recommended that biochemical(PSA) recurrence following radical prostatectomy be defined as a serum PSA of 0.2ng/ml or greater, with a second confirmatory level of PSA of ≥0.2ng/ml. It is important to bear in mind that this in no way is proposed as a threshold value suggestive of initiation of salvage therapy nor a predictor of death from prostate cancer. Once PSA recurrence after RP has been diagnosed, it is important to determine whether the recurrence has developed at local or distant sites because managementof PSA failure is dependent on the site of recurrence. In general, digital rectal examination is not useful in men with undetectable or very low PSA levels. Conventional diagnostic imaging, such as computed tomography(CT) and bone scintigraphy, very often are not able to detect whether the recurrence has developed at local and/or distant(systemic) sites. PSA velocity and the slope of PSA increase seem to be the most important predictors of distant metastases. The definition of PSA recurrence after radiation therapy has also been debated. Currently, although not without controversy, the most commonly used definition was developed by the ASTRO Consensus Panel. This definition requires 3 consecutive increases in PSA after nadir has been reached, with the date of failure being the midpoint between the nadir and the first of 3 consecutive rises. A second ASTRO and the Radiation Therapy Oncology Group Consensus Conference revised the ASTRO definition. The panel recommended a rise by 2ng/ml or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT and the date of failure be determined ’at call’(not backdated). Follwing RT, diagnostic procedures for PSA relapse such as endorectal MRI is valuable for men who are candidate for radical salvage prostatectomy.
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KEYWORD
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Prostate neoplasms, Recurrence, Prostate
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