209103

Radikal prostatektomi sonrası PSA relapsına tanısal ve tedavi yaklaşımı

Radikal prostatektomi RP sonrası hastaların %20-30’unda klinik veya radyolojik metastaz bulgusu olmadan PSA artışı olur. RP sonrası meydana gelen PSA relapsı prostatik yataktaki lokal hastalığa, pelvik lenf nodlarındaki bölgesel hastalığa, uzak metastaza veya lokal ve uzak metastaz kombinasyonuna bağlı olabilir. Bu durumlardan hangisine bağlı PSA relapsı olduğunu öngörmede ilk PSA değeri, PSA relaps zamanı ve PSA ikilenme zamanı çok önemlidir. RP sonrası biyokimyasal relaps BKR tedavi zamanı ve şekli tartışmalıdır. PSA relapslı hastaların tedavisinde dikkate alınması gereken noktalar hastanın beklenen yaşam beklentisi, PSA artışının lokal veya sistemik hastalığın hangisinden kaynaklandığı, klinik progresyon riski ve PSA düzeyi ve kinetiği’dir. Prostatik yatağa radyoterapi, androjen deprivasyon tedavisi ve gözlem bu hastalarda düşünülebilecek tedavi yöntemleridir

Anahtar Kelimeler:

Prostat kanseri, radikal prostatektomi, PSA relapsı

Diagnostic and therapeutic approach to PSA relaps after radical prostatectomy

After radical prostatectomy RP , 20-30% of the patients has PSA relaps without clinical or radiologic findings of the metastasis. PSA relaps after RP may be due to local disease in the prostatic bed, nodal involvement in pelvic area, distant metastasis or combination of local and metastatic disease. First PSA level, PSA relaps time and PSA doubling time are very important to predict the reason of PSA relaps after RP. Treatment type and treatment time of PSA relaps after RP are controversial. Expected life time, the reason of PSA relaps as local or metastatic disease, risk of clinical progression, PSA level and PSA kinetics are important criteria to be considered in the treatment of these patients. Radiation therapy to prostatic bed, androgen deprivation therapy and watchfull waiting are options for the treatment

Keywords:

Prostate cancer, radical prostatectomy, PSA relaps,

___

Partin AW, Oesterling JE. The clinical usefulness of prostate speci- ficantigen: update 1994. J Urol. 1994;152:1358-68.
Han M, Partin AW, Chan DY, Walsh PC. An evaluation of the dec- reasing incidence of positive surgical margins in a large retropubic prostatectomy series. J Urol. 2004;171(1):23-6.
Karakiewicz PI, Eastham JA, Graefen M, Cagiannos I, Stricker PD, Klein E, Cangiano T, Schröder FH, Scardino PT, Kattan MW. Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients. Urology. 2005;66(6):1245-50.
Sella T, Schwartz LH, Swindle PW, Onyebuchi CN, Scardino PT, Scher HI, Hricak H. Suspected local recurrence after radical prostatec- tomy: endorectal coil MR imaging. Radiology. 2004 ;231(2):379-85.
Rischke HC, Knippen S, Kirste S, Grosu AL. Treatment of recurrent prostate cancer following radical prostatectomy: the radiation-oncolo- gists point of view. Q J Nucl Med Mol Imaging. 2012;56(5):409-20.
Zagars GK. Prostate-specific antigen as a prognostic factor for prostate cancer treated by external beam radiotherapy. Int J Radiat Oncol Biol Phys. 1992;23(1):47-53.
Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation fol- lowing radical prostatectomy. JAMA. 1999;281(17):1591-7.
Beard C, Chen MH, Cote K, Loffredo M, Renshaw A, Hurwitz M, D'Amico AV. Pretreatment predictors of posttreatment PSA doubling ti- mes for patients undergoing three-dimensional conformal radiotherapy for clinically localized prostate cancer. Urology. 2005 ;66(5):1020-3.
Naito S. Evaluation and management of prostate-specific antigen recurrence after radical prostatectomy for localized prostate can- cer. Jpn J Clin Oncol. 2005;35(7):365-74.
Carthon BC, Marcus DM, Herrel LA, Jani AB, Rossi PJ, Canter DJ. Therapeutic options for a rising PSA after radical prostatec- tomy. Can J Urol. 2013 ;20(3):6748-55.
Scher HI, Eisenberger M, D'Amico AV, Halabi S, Small EJ, Mor- ris M, Kattan MW, Roach M, Kantoff P, Pienta KJ, Carducci MA, Agus D, Slovin SF, Heller G, Kelly WK, Lange PH, Petrylak D, Berg W, Higano C, Wilding G, Moul JW, Partin AN, Logothetis C, Soule HR. Eligibility and outcomes reporting guidelines for clinical trials for patients in the state of a rising prostate-specific antigen: re- commendations from the Prostate-Specific Antigen Working Group. J Clin Oncol. 2004;22(3):537-56.J Clin Oncol. 2004 ;22(3):537-56.
Stephenson AJ, Kattan MW, Eastham JA, Dotan ZA, Bianco FJ Jr, Lilja H, Scardino PT. Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol. 2006;24(24):3973-8.
Amling CL, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point? J Urol. 2001;165(4):1146-51.
Darwish OM, Raj GV. Management of biochemical recurrence after primary localized therapy for prostate cancer. Front Oncol. 2012;2:48. doi:10.3389/fonc.2012.00048. eCollection 2012.
Jhaveri FM, Zippe CD, Klein EA, Kupelian PA. Biochemical failure does not predict overall survival after radical prostatec- tomy for localized prostate cancer: 10-year results. Urology. 1999;54(5):884-90.
Simmons MN, Stephenson AJ, Klein EA. Natural history of bioc- hemical recurrence after radical prostatectomy: risk assessment for secondary therapy. Eur Urol. 2007;51(5):1175-84.
Mandel P, Steuber T, Ahyai S, Kriegmair M, Schiffmann J, Boehm K, Heinzer H, Michl U, Schlomm T, Haese A, Huland H, Graefen M, Tilki D. Salvage radical prostatectomy for recurrent prostate cancer: verification of European Association of Urology guideline criteria. BJU Int. 2015. doi: 10.1111/bju.13103.
Saleem MD, Sanders H, Abu El Naser M, El-Galley R. Factors predicting cancer detection in biopsy of the prostatic fossa after radical prostatectomy. Urology. 1998;51(2):283-6.
Rouvière O, Vitry T, Lyonnet D. Imaging of prostate cancer local recurrences: why and how? Eur Radiol. 2010;20(5):1254-66.
Beresford MJ, Gillatt D, Benson RJ, Ajithkumar T. A systematic review of the role of imaging before salvage radiotherapy for post- prostatectomy biochemical recurrence. Clin Oncol (R Coll Radi- ol). 2010;22(1):46-55.
Calabria F, Rubello D, Schillaci O. The optimal timing to perform 18F/11C-choline PET/CT in patients with suspicion of relapse of prostate cancer: trigger PSA versus PSA velocity and PSA doub- ling time. Int J Biol Markers. 2014;29(4):e423-30.
Castellucci P, Ceci F, Graziani T, Schiavina R, Brunocilla E, Maz- zarotto R, Pettinato C, Celli M, Lodi F, Fanti S. Early biochemical relapse after radical prostatectomy: which prostate cancer patients may benefit from a restaging 11C-Choline PET/CT scan before salvage radiation therapy? J Nucl Med. 2014;55(9):1424-9.
Fuccio C, Castellucci P, Schiavina R, Guidalotti PL, Gavaruzzi G, Montini GC, Nanni C, Marzola MC, Rubello D, Fanti S. Role of 11C-choline PET/CT in the re-staging of prostate cancer patients with biochemical relapse and negative results at bone scintigraphy. Eur J Radiol. 2012;81(8):e893-6.
Stephenson AJ, Scardino PT, Kattan MW, Pisansky TM, Slawin KM, Klein EA, Anscher MS, Michalski JM, Sandler HM, Lin DW, Forman JD, Zelefsky MJ, Kestin LL, Roehrborn CG, Cat- ton CN, DeWeese TL, Liauw SL, Valicenti RK, Kuban DA, Pol- lack A. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25(15):2035-41.
Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL, Partin AW, Walsh PC. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical re- currence after radical prostatectomy. JAMA. 2008;299(23):2760-9.
Boorjian SA, Thompson RH, Tollefson MK, Rangel LJ, Bergstralh EJ, Blute ML,Karnes RJ. Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: the impact of time from surgery to recurrence. Eur Urol. 2011;59(6):893-9.
Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, Scardino PT, Eastham JA, Zelefsky MJ. Improved toxicity profile following high-dose postprostatectomy salvage radiati- on therapy with intensity-modulated radiation therapy. Eur Urol. 2011;60(6):1142-8.
Ost P, Lumen N, Goessaert AS, Fonteyne V, De Troyer B, Jacobs F, De Meerleer G. High-dose salvage intensity-modulated radiot- herapy with or without androgen deprivation after radical prosta- tectomy for rising or persisting prostate-specific antigen: 5-year results. Eur Urol. 2011;60(4):842-9.
Soto DE, Passarelli MN, Daignault S, Sandler HM. Concurrent androgen deprivation therapy during salvage prostate radiotherapy improves treatment outcomes in high-risk patients. Int J Radiat Oncol Biol Phys. 2012;82(3):1227-32.
Moul JW, Wu H, Sun L, McLeod DG, Amling C, Donahue T, Ku- suda L, Sexton W, O'Reilly K, Hernandez J, Chung A, Soderdahl D. Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatec- tomy. J Urol. 2004;171(3):1141-7.
Shariat SF, Hammerich KH. Words of wisdom. Re: Timing of andro- gen deprivation therapy and its impact on survival after radical pros- tatectomy: a matched cohort study. Siddiqui SA, Boorjian SA, Inman B, Bagniewski S, Bergstralh EJ, Blute ML. J Urol 2008;179:1830-7.
Garcia-Albeniz X, Chan JM, Paciorek A, Logan RW, Kenfield SA, Cooperberg MR, Carroll PR, Hernán MA. Immediate versus de- ferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse. An observational follow-up study. Eur J Cancer. 2015;51(7):817-24.
Saigal CS. Moving beyond guidelines to improve the quality of care for men with prostate cancer. J Clin Oncol. 2007 ;25(34):5348-9.
Tsai HK, D'Amico AV, Sadetsky N, Chen MH, Carroll PR. And- rogen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. J Natl Cancer Inst. 2007; 99(20):1516-24.
Mottett N, Bellmunt J, Briers E, van den Bergh RCN, Bolla M,. van Casteren NJ, Cornford P, Culine S, Joniau S, Lam T, Mason MD, Matveev V, van der Poel H, van der Kwast TH, Rouvière O, Wiegel T. Guidelines on prostate cancer. European Association of Urology, 2015
Carthon BC, Marcus DM, Herrel LA, Jani AB, Rossi PJ, Canter DJ. Therapeutic options for a rising PSA after radical prostatectomy- Can J Urol. 2013; 20(3):6748-55.