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Commentary RE: Evaluation of Serum Prostate-Specific Antigen Velocity After Radical Prostatectomy to Distinguish Local Recurrence From Distant Metastasis

  • Charles R. Pound
    Correspondence
    Address correspondence to: Charles R. Pound, M.D., University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4500.
    Affiliations
    University of Mississippi Medical Center, Jackson, MS
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      With the introduction of widespread prostate-specific antigen (PSA) screening in the 1980s, radical retropubic prostatectomy rapidly gained popularity as a treatment option for men with clinically localized prostate cancer. Although the likelihood of long-term cure from prostate cancer with surgery as a single modality therapy was excellent in men with organ confined disease, approximately one third of men experienced biochemical recurrence as the only clinical indicator of disease following surgery. The significance of these small changes in the PSA level following surgery was uncertain and resulted in anxiety both for the patients and their surgeons alike. The definition of a biochemical recurrence following radical prostatectomy was not universal at that time with different institutions utilizing different levels of PSA to trigger a search for disease and consideration of salvage therapy.
      • Cookson MS
      • Aus G
      • Burnett AL
      • et al.
      Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendation for a standard in the reporting of surgical outcomes.
      Urologists were still almost a decade away from national guidelines to direct the assessment and treatment of these men.
      • Thompson IM
      • Valicenti RK
      • Albertsen P
      • et al.
      Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline.
      The benefit of early hormonal therapy was controversial in these asymptomatic men and many of them had chosen surgery as primary therapy in the hope of avoiding the potential side effects of pelvic radiation.
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      References

        • Cookson MS
        • Aus G
        • Burnett AL
        • et al.
        Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendation for a standard in the reporting of surgical outcomes.
        J Urol. 2007; 177: 540-545
        • Thompson IM
        • Valicenti RK
        • Albertsen P
        • et al.
        Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline.
        J Urol. 2013; 190: 441-449
        • Carter HB
        • Pearson JD
        • Metter EJ
        • et al.
        Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease.
        JAMA. 1992; 267: 2215-2220
        • D'Amico AV
        • Hanks GE
        Linear regressive analysis using prostate-specific antigen doubling time for predicting tumor biology and clinical outcome in prostate cancer.
        Cancer. 1993; 72: 2638-2643
        • Leapman MS
        • Nguyen HG
        • Cowan JE
        • et al.
        Comparing prognostic utility of a single-marker immunohistochemistry approach with commercial gene expression profiling following radical prostatectomy.
        Eur Urol. 2018; 74: 668-675
        • Klein EA
        • Yousefi K
        • Haddad Z
        • et al.
        A genomic classifier improves prediction of metastatic disease within 5-years after surgery in node-negative high-risk prostate cancer patients managed by radical prostatectomy without adjuvant therapy.
        Eur Urol. 2015; 67: 778-786
        • Uprimny C
        • Kroiss AS
        • Fritz J
        • et al.
        Early PET imaging with [68]Ga-PMSA-11 increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence.
        Eur J Nucl Med Mol Imaging. 2017; 44: 1647-1655
        • Panebianco V
        • Sciarra A
        • Lisi D
        • et al.
        Prostate cancer: 1HMRS-DCEMR at 3T versus [(18)F] choline PET/CT in the detection of local prostate cancer recurrence in men with biochemical progression after radical retropubic prostatectomy (RRP).
        Eur J Radiol. 2012; 81: 700-708