Management of High Risk Metastatic Prostate Cancer: Defining Risk at the Time of Initial Treatment Failure

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Abstract
Even as improvements in therapy success continue, initial treatment for prostate cancer fails in a substantial proportion of patients with apparently localized disease. However, the optimal approaches to defining biochemical failure and determining its clinical significance remain unclear. A focused review and search of current literature were performed regarding biochemical recurrence and risk stratification after initial therapy for prostate cancer. Multiple definitions exist for prostate specific antigen failure after therapy for localized and metastatic prostate cancer. The timing of prostate specific antigen recurrence as well as prostate specific antigen kinetic characteristics, such as prostate specific antigen velocity and most significantly prostate specific antigen doubling time, impacts the prediction of posttreatment cancer specific and overall survival after biochemical recurrence is detected. In addition, as with determining the recurrence risk, Gleason score and pathological stage also can predict the survival likelihood. In most cases biochemical prostate specific antigen recurrence is the initial indicator of treatment failure and eventual progression but prostate specific antigen recurrence alone does not predict clinically significant events. As with determining the risk likelihood, pathological data and prostate specific antigen kinetic characteristics can help predict patient survival.

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