Managing relapse after radical treatment

NICE suggest that (1):

• analyse serial PSA levels after radical treatment using the same assay technique
  
  
• biopsy of the prostatic bed should not be performed in men with prostate cancer who have had a radical prostatectomy
  
  
• biopsy of the prostate after radiotherapy should only be performed in men with prostate cancer who are being considered for local salvage therapy in the context of a clinical trial
  
  
• for men with evidence of biochemical relapse following radical treatment and who are considering radical salvage therapy:
  • routine MRI scanning should not be performed prior to salvage radiotherapy in men with prostate cancer
  • an isotope bone scan should be performed if symptoms or PSA trends are suggestive of metastases
    
    
• biochemical relapse (a rising PSA) alone should not necessarily prompt an immediate change in treatment
  
  
• biochemical relapse should trigger an estimate of PSA doubling time, based on a minimum of 3 measurements over at least a 6 month period
  
  
• men with biochemical relapse after radical prostatectomy, with no known metastases, should be offered radical radiotherapy to the prostatic bed
  
  
• men with biochemical relapse should be considered for entry to appropriate clinical trials
  
  
• hormonal therapy is not routinely recommended for men with prostate cancer who have a biochemical relapse unless they have:
  • symptomatic local disease progression, or
  • any proven metastases, or
  • a PSA doubling time of < 3 months

Reference:

• (1) NICE (January 2014).Prostate cancer Diagnosis and treatment