Prostate Cancer Recurrence After Radical Prostatectomy

European Urological Review, 2009;4(1):27-30

Prostate cancer is the most commonly detected male cancer and the second leading cause of male cancer deaths in the US and Europe.1 Most new cases are localised to the prostate and found in men between 60 and 70 years of age, with only a subset of these cases progressing to symptomatic or metastatic disease within the patient’s lifetime. Open retropubic radical prostatectomy remains the gold standard for curative treatment of T1–2 prostate carcinomas, as it significantly reduces mortality, the risk of local progression and the onset of distant metastases.2 In addition, the incidence of locally advanced prostate cancer at the time of diagnosis has decreased due to the advent of serum prostate-specific antigen (PSA) screening.3 However, the surgical approach has gone through rapid changes, and the open procedure initially described by Walsh et al. has evolved considerably over the past two decades.4,5 In the meantime, laparoscopic and robotic approaches have been developed by several groups.6–9 Also, recent progress in surgical techniques (e.g. laparoscopic and retropubic procedures) has reduced complication rates.10,11 Nevertheless, the effectiveness of local tumour control after radical prostatectomy for localised prostate cancer is still a matter of debate.12,13 Prognosis is directly related to stage at diagnosis and treatment.

Following primary curative treatment, approximately 35% (15–53%) of patients develop biochemical recurrence.5,8,14 For the majority of these patients, the first sign of recurrent disease is a rising PSA level without either clinical or radiographic evidence of disease.15 Rising PSA levels after radical prostatectomy may be due to a local recurrence in the prostatic bed, occult distant metastases or a combination of both. However, unfortunately it is quite difficult to identify recurrent lesions accurately at an early stage of PSA recurrence. This article deals with the diagnosis and management of recurrence after radical prostatectomy.

Definition of Recurrence After Radical Prostatectomy
The care of prostate cancer patients following initial treatment is difficult due to a lack of specific biomarkers. While PSA can be used to detect recurrence, prior to the development of clinical disease its baseline values do not allow prognostic prediction of disease behaviour. While changes in PSA value over time (such as PSA velocity) can be used to derive information about tumour phenotype, there is an urgent clinical need for an accurate prognostic marker that could identify men at high risk of relapse and metastasis development.16,17

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