Treating High-Risk or Recurrent Prostate Cancer: Risk of Relapse Despite Treatment
Various tools have been developed to assist patients and doctors trying to decide on treatment for prostate cancer by predicting the efficacy of and likelihood of cure with surgery or radiation therapy. The main pretreatment factors that predict the likelihood of cure, as defined by the ability to suppress and maintain low levels of prostate-specific antigen (PSA) without androgen deprivation, are PSA level, clinical stage by digital rectal exam, Gleason score, and extent of disease by biopsy. These factors are a general means of assessing the volume and biologic aggressiveness of prostate cancer and, thus, the likelihood that the cancer will spread beyond the prostate.
Researchers have evaluated how the “PSA doubling time” (how quickly PSA is rising) before treatment affects cure. Some studies have found that an increase in PSA of greater than 2 ng/mL in the year preceding the diagnosis predicted a higher risk of recurrence and a higher likelihood of death despite therapy.
Studies have shown that some patients are at high risk for biochemical progression (further cancer growth), regardless of whether they had surgery or radiation, if they had a pretreatment PSA level greater than 20 ng/mL or advanced cancer (stage T2b or greater) or high-grade disease (Gleason score of 8 to 10). Many men with a PSA level of 10 to 20 ng/mL or stage T2a cancer or intermediate-grade disease (Gleason score of 7) also have an unacceptably high risk of relapse.