Biochemical recurrence

Biochemical Recurrence
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Rising prostate-specific antigen (PSA) levels
Complications	Metastasis, cancer progression
Onset	Variable
Duration	Indefinite
Types	N/A
Causes	Residual cancer cells post-treatment
Risks	Previous prostate cancer treatment
Diagnosis	PSA testing
Differential diagnosis	N/A
Prevention	N/A
Treatment	Hormone therapy, radiation therapy, surveillance
Medication	N/A
Prognosis	Variable
Frequency	N/A
Deaths	N/A

Overview

Biochemical recurrence (BCR) refers to the rise in prostate-specific antigen (PSA) levels in the blood of a patient who has undergone treatment for prostate cancer, such as radical prostatectomy or radiation therapy. It is an indication that cancer cells may still be present in the body, despite the absence of clinical or radiographic evidence of disease.

Pathophysiology

Biochemical recurrence occurs when residual prostate cancer cells continue to produce PSA, a protein produced by both normal and malignant cells of the prostate gland. After definitive treatment, such as surgery or radiation, PSA levels should drop to undetectable levels. A subsequent rise in PSA levels suggests the presence of residual cancerous tissue.

Diagnosis

The diagnosis of biochemical recurrence is primarily based on serial measurements of PSA levels. The American Urological Association (AUA) defines biochemical recurrence after radical prostatectomy as a PSA level of 0.2 ng/mL or higher, confirmed by a second test. After radiation therapy, the Phoenix definition is used, which defines BCR as a rise of 2 ng/mL or more above the nadir PSA level.

Risk Factors

Several factors can increase the risk of biochemical recurrence, including:

• High pre-treatment PSA levels
• Advanced Gleason score
• Positive surgical margins
• Extracapsular extension
• Seminal vesicle invasion

Management

The management of biochemical recurrence depends on several factors, including the patient's overall health, the time to recurrence, and the PSA doubling time. Options include:

Active Surveillance

In some cases, especially when the PSA doubling time is long, active surveillance may be appropriate. This involves regular monitoring of PSA levels and clinical evaluation without immediate intervention.

Salvage Therapy

For patients with a higher risk of progression, salvage therapy may be considered. This can include:

• Salvage Radiation Therapy: Often used after radical prostatectomy if there is no evidence of distant metastasis.
• Hormone Therapy: Androgen deprivation therapy (ADT) can be used to lower testosterone levels, which prostate cancer cells need to grow.

Clinical Trials

Patients may also be eligible for clinical trials investigating new treatments for biochemical recurrence.

Prognosis

The prognosis for patients with biochemical recurrence varies widely. Factors influencing prognosis include the PSA doubling time, the time from initial treatment to recurrence, and the presence of other high-risk features. Some patients may live many years without progression to clinical disease, while others may experience rapid progression.

Conclusion

Biochemical recurrence is a significant concern for patients treated for prostate cancer. Early detection and appropriate management are crucial to improving outcomes. Ongoing research continues to refine the understanding and treatment of this condition.

See Also

• Prostate cancer
• Prostate-specific antigen
• Radical prostatectomy
• Radiation therapy