13 Feb Treatment Choices Cloudy If PSA Remains Elevated After Prostatectomy
MedicalResearch.com Interview with:
Dr. rer. nat. Detlef Bartkowiak
Klinik für Strahlentherapie und Radioonkologie
Universitätsklinikum Ulm Albert-Einstein-Allee
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Bartkowiak: After surgery of prostate cancer, the lab marker for prostate specific antigen PSA should fall below detection limits. If the PSA does not decline, this can be a due to residual normal prostate tissue but also due to tumor cells remaining in the patient. If it is tumor cells residing in or near the area of the resected prostate, then this can be treated locally with radiotherapy. If the tumor has already produced metastases at remote sites of the body, irradiating the prostate region is pointless. In our clinical trial into post-operative therapy options, patients who did not achieve an undetectable PSA after radical prostatectomy received additional radiotherapy with 66 Gy. Despite this immediate treatment, the risk of recurrence within 10 years was 37%. Therefore, a more aggressive early treatment should be considered in such patients.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Bartkowiak: If the PSA remains detectable after radical prostatectomy, the patient and the attending physician must weigh up the risk of recurrence vs. the risk of treatment related side effects and potential of complications. An appropriate early and aggressive therapy could involve intensity-modulated radiotherapy with at least 70 Gy and additional anti-hormonal treatment. However, for a considerable number of patients, this may establish overtreatment.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Bartkowiak: So far, we cannot reliably predict whether an individual patient with post-prostatectomy PSA persistence can be cured with local treatment alone. In our study, 63% of the patients who initially retained a detectable PSA are free of progression 10 years after surgery plus immediate radiotherapy, but 37% experienced recurrence. Thus, improved imaging or surrogate markers beyond PSA are desirable to distinguish risk groups among men with PSA persistence. To that end, larger clinical trials are required to develop risk-adjusted recommendations for standardized therapy.
Thomas Wiegel, MD Detlef Bartkowiak, PhD Dirk Bottke, MD, Reinhard Thamm, M Axel Hinke, PhD Michael Stöckle, MD Christian Rübe, MD Axel Semjonow, MDManfred Wirth, MD Stephan Störkel, MD Reinhard Golz, MD,Rita Engenhart-Cabillic, MD,
Rainer Hofmann, MD, Horst-Jürgen Feldmann, MD,Tilman Kälble, MD,
Alessandra Siegmann, MD, Wolfgang Hinkelbein, MD, Ursula Steiner, MD,
Kurt Miller, MD
International Journal of Radiation Oncology*Biology*Physics
Volume 91, Issue 2, 1 February 2015, Pages 288–294
MedicalResearch.com Interview with: Dr. rer. nat. Detlef Bartkowia (2015). Treatment Choices Cloudy If PSA Remains Elevated After Prostatectomy MedicalResearch.com