Info

🌱 來自: Recurrent or Metastatic Prostate Cancer

Biochemical recurrence of mPCa

Definition

• Rising PSA after definitive RP: Undetectable PSA after RP w/ subsequent detectable PSA (≥0.2 ng/mL) that is → confirmed on at ↣ least 2 subsequent determinations (J Urol 2007;177(2):540)
• Rising PSA after definitive RT: Rise of PSA by 2 ng/mL or more above the nadir PSA (Int J Radiat Oncol Biol Phys 2006;65(4):965). Usually confirmed to r/o “PSA Bounce.” Nadir may take up to 18 mos post RT to achieve

Workup

• Evaluate risk of metastases or death: Higher risk for PSA doubling time (≤12 mos), Gleason score (≥8), time to biochemical failure ≤18 mos post RT (Eur Urol 2019;75(6):896). Consider age, life expectancy, comorbidities
• R/o local recurrence, regional (pelvic LNs most common) or distant metastases (bone most common). Bone scan, CT/MRI/TRUS, C11-Choline PET, prostate bx
• Local recurrence may be detected by MRI: Post RT-aim to bx, if possible. Post RP-role of bx controversial
• Difficult to detect distant dz w/ CT/Bone Scan at ↣ PSA <10 ng/mL. If high suspicion & pt a candidate for salvage therapy, consider 68Ga/18F-PSMA PET/CT or 18F-Fluciclovine from PSA ≥0.5 ng/mL, if available

Management

• BCR post RP
• If no distant mets: Consider salvage RT to prostate bed ± pelvic LN radiation ± ADT
• If not fit for salvage RT: ADT or observation, consider intermittent ADT
• BCR post RT
• Local tx options: RP, cryosurgery, high-intensity focused U/S, brachytherapy ± ADT
• Candidate for salvage surgery if original T1-T2, NX or N0, life expectancy >10 y, current PSA <10 ng/mL
• If no distant mets identified, prostate bx neg, or not candidate for salvage: Observation vs. ADT, consider intermittent ADT