Variation In The Definition Of Biochemical Recurrence In Patients Treated For Localized Prostate Cancer

UroToday.com- One of the problems with prostate cancer outcomes studies is the lack of standardization in the definition of "treatment failure". While after radical prostatectomy most experts would agree that a serum PSA concentration greater than 0.2 ng/ml constitutes a recurrence, some institutions use 0.1 ng/ml and others use 0.4 ng/ml. What may seem like minute differences in PSA become relevant and provoke anxiety to the physician and patient trying to decide when to begin salvage radiotherapy. Furthermore, varying definitions makes comparisons across studies difficult.

For patients treated with radiotherapy, the most commonly used definition for biochemical recurrence has been the ASTRO "3 consecutive PSA rises" definition. In the last several years some experts have suggested that a "nadir plus 2 ng/ml" definition may be more accurate. This defines the biochemical failure event when the patient's PSA rises 2 ng/ml above the nadir.

Cookson and colleagues from the AUA Prostate Guidelines for Localized Prostate Cancer Update Panel Report searched PubMed and reviewed 13,800 articles published between 1991 and 2004 which included the terms prostate cancer and prostatic neoplasm. A total of 436 articles dealing with clinical T1 and T2N0M0 prostate cefinition of biochemical recurrence. Of 53 different definitions of biochemical failure afancer were identified; articles were stratified according to the dter radical prostatectomy identified, the most common was a PSA elevation of 0.2 ng/ml or greater (35/53). With regards to radiation therapy, 208 articles were identified reporting 99 varying definitions of biochemical failure. The most common definition for radiation failure was the ASTRO "3 consecutive rises definition".

After reviewing the available data, the panel recommended using a serum PSA of 0.2 ng/ml or greater for biochemical recurrence after prostatectomy and the ASTRO definition for patients treated with radiotherapy. The authors acknowledged that in the future ASTRO may change the "3 consecutive rises" definition to a "nadir plus 2 ng/ml" or "nadir plus 1 ng/ml" definition. Most importantly, these definitions are intended to be used to facilitate comparisons between studies, and not as guidelines to initiate salvage treatment.

Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen C, Thrasher JB, Thompson I

J Urol ; 177(2): 540-5

Reviewed by UroToday.com Contributing Editor Ricardo F. SГЎnchez-Ortiz, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2006 - UroToday