They advocate the Phoenix definition of PSA failure, which is the PSA nadir plus 2ng/ml. In those with recurrence and contemplating salvage therapy a prostate biopsy should be performed. Staging should be performed using contrast enhanced dynamic MRI of the prostate. The authors reviewed the Prostascint scan but based upon their interpretation of the literature did not favor it.

For high risk cases (PSA >10ng/ml, Gleason score >7, PSADT <1 year) laparoscopic pelvic lymphadenectomy and bone scan are performed to evaluate for metastatic disease. Risk assessment is defined as follows; low risk is PSA<5ng/ml, Gleason score <6, stage 1 year. Moderate risk is PSA>5ng/ml, Gleason score >7 and who do not otherwise qualify as high risk and high risk is 2 of; PSA>10ng/ml, Gleason score >8, and PSADT <10 months.

Following risk assessment the patient should undergo counseling of all options. Active treatment options include delayed androgen deprivation therapy, salvage radical prostatectomy, salvage prostate cryotherapy, salvage brachytherapy, and salvage high intensity focused ultrasound.

Dudderidge T, Payne H and Emberton M

BJU Int. ePub, June 15, 2007
doi:10.1111/j.1464-410X.2007.06999.x

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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