After primary treatments, a period of remission is followed
until cancer cells start to resurface again. The period of remission will
depend on the age, health and type and effectiveness of primary treatments.
Five years remission is considered the gold standard, before failure situations
occurs, followed by PSA anxieties.
Failure situations.
a. A
biochemical failure occurs when the PSA rises again but there is no visible
evidence of cancer on the MRI/ CT scan, bone scan or any other imaging.
b. Local
failure occurs when PSA rises with the disease recurring in the area of the
prostate gland.
c. Distant
failure occurs when PSA rises as metastases show up in other parts of the body.
Milestones to note
a. Failure
of EBRT is deemed when the PSA value of 2 ng/mL is greater than the absolute
nadir it represents. Nadir is the lowest PSA value achieved post treatments and
during remission.
b. Biochemical
recurrence post ERBT is seen in having more than 3 consecutive PSA risings
after achieving PSA nadir.
The
Phoenix Definition for cancer
recurrence is nadir point plus 2 ng/mL. The definition is valid only after two
years PSA test past radiation treatment. Nadir point is the lowest PSA reading
after treatment. It is reached at 12 to 42 months after treatment should be
under 0.5ng/ml and no further rise. (Phoenix definition. An annual
conference of Oncologist defines cancer recurrence.)
The value of PSA at 2 ng/mL plus PSA nadir (as in (a) above) is considered the gold standard when to take salvage therapies.
The value of PSA at 2 ng/mL plus PSA nadir (as in (a) above) is considered the gold standard when to take salvage therapies.
Options for salvage
treatments
Salvage Therapies are the blanket term used for medical
treatments when initial treatments failed.
These treatments may include:
a. Salvage
/ Adjuvant radiation.
b. Surgery
(Radical Prostatectomy).
c. Cryosurgery.
(Freezing)
d. High
Intensity Focus Ultrasound (HIFU).
e. Systemic
treatment via hormone ablation.
Take care
Allen Lai
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