Question

Discuss management of biochemical recurrence.

Hint:

Early intervention is crucial in managing biochemical recurrence effectively, especially with salvage therapies like radiation and ADT to prevent further disease progression.

Answer 1

Step 1: Monitoring:
After detecting biochemical recurrence, the first step is to monitor the patient closely. This includes regular PSA testing to assess the rate of increase and any changes in PSA doubling time, which can provide insight into the aggressiveness of the recurrence.
Step 2: Imaging:
In cases of rising PSA, imaging studies such as MRI, CT scans, or PET scans (especially with prostate-specific membrane antigen (PSMA) PET) are used to detect the site of recurrence, whether local, regional, or distant.
Step 3: Treatment Options:
The treatment of biochemical recurrence may involve: 1. Salvage Radiation Therapy: For patients with localized recurrence, especially those who had a previous radical prostatectomy.
2. Androgen Deprivation Therapy (ADT): Often used in combination with radiation or as a monotherapy to reduce testosterone levels, which drive prostate cancer growth.
3. Chemotherapy or Immunotherapy: For patients with advanced or metastatic recurrence.
4. Prostatectomy or Local Ablation: In some cases, if the recurrence is localized, surgical resection or cryotherapy can be considered.

Step 4: Considerations:
The choice of treatment depends on factors such as the patient's overall health, the PSA doubling time, the location of recurrence, and prior treatments. A multidisciplinary approach involving urologists, oncologists, and radiologists is often needed.