This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, A. K. Articles by D'Amico, A. V. Search for Related Content PubMed PubMed Citation Articles by Lee, A. K. Articles by D'Amico, A. V.

Utility of Prostate-Specific Antigen Kinetics in Addition to Clinical Factors in the Selection of Patients for Salvage Local Therapy

Andrew K. Lee, Anthony V. D'Amico

The University of Texas M.D. Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital; Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA

Address reprint requests to Andrew K. Lee, MD, MPH, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1202, Houston, TX 77030-4009; e-mail: aklee{at}mdanderson.org.

A detectable and rising prostate-specific antigen (PSA) level after radical prostatectomy or a rising PSA above the nadir value after radiation therapy may represent a local failure, distant failure, or both. Determining the site or sites of failure is critical for selecting the appropriate salvage therapy. Nevertheless, although PSA failure precedes clinically evident failure by several years, determining the source of the biochemical failure is often not possible using currently available diagnostic studies.

Selecting the optimal therapeutic approach may be guided by the initial clinical factors (eg, T-category, PSA, biopsy Gleason score). If the patient has had a radical prostatectomy, then the pathologic outcomes of the surgery (eg, pathologic T-category and prostatectomy Gleason score, nodal and margin status) may provide further information. Beyond pretreatment clinical and post-treatment pathologic factors, PSA kinetics, and specifically a pretreatment PSA velocity > 2 ng/mL/year, an interval to PSA failure < 3 years and a post-treatment PSA doubling time < 3 months place a man at increased risk for metastases and subsequent prostate cancer–specific mortality, making these men poor candidates for local-only salvage therapy.

Therefore, the optimal candidate for local-only salvage therapy is a man whose pretreatment PSA velocity was 2 ng/mL/year or less, interval to PSA failure exceeds 3 years, and post-treatment PSA doubling time is at least 12 months, and who did not have biopsy or prostatectomy Gleason score of 8 to 10 or seminal vesicle or lymph node involvement.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				S. F. Shariat, J. A. Karam, J. Walz, C. G. Roehrborn, F. Montorsi, V. Margulis, F. Saad, K. M. Slawin, and P. I. Karakiewicz Improved Prediction of Disease Relapse after Radical Prostatectomy through a Panel of Preoperative Blood-Based Biomarkers Clin. Cancer Res., June 15, 2008; 14(12): 3785 - 3791. [Abstract] [Full Text] [PDF]

				V. Kundra, P. M. Silverman, S. F. Matin, and H. Choi Imaging in Oncology from The University of Texas M. D. Anderson Cancer Center: Diagnosis, Staging, and Surveillance of Prostate Cancer Am. J. Roentgenol., October 1, 2007; 189(4): 830 - 844. [Abstract] [Full Text] [PDF]

				S. F. Shariat, K. Bensalah, J. A. Karam, C. G. Roehrborn, A. Gallina, Y. Lotan, K. M. Slawin, and P. I. Karakiewicz Preoperative Plasma HER2 and Epidermal Growth Factor Receptor for Staging and Prognostication in Patients with Clinically Localized Prostate Cancer Clin. Cancer Res., September 15, 2007; 13(18): 5377 - 5384. [Abstract] [Full Text] [PDF]

				A. J. Stephenson, P. T. Scardino, M. W. Kattan, T. M. Pisansky, K. M. Slawin, E. A. Klein, M. S. Anscher, J. M. Michalski, H. M. Sandler, D. W. Lin, et al. Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer After Radical Prostatectomy J. Clin. Oncol., May 20, 2007; 25(15): 2035 - 2041. [Abstract] [Full Text] [PDF]

				E. J. Small and E. A. Klein Challenges and Future Directions in the Prevention and Management of Prostate Cancer J. Clin. Oncol., November 10, 2005; 23(32): 8143 - 8145. [Full Text] [PDF]