Abstract
When faced with biochemical recurrence after definitive radiotherapy for prostate cancer, clinicians must determine whether the recurrence is local or systemic. Post radiotherapy prostate biopsies to detect persistent local disease are difficult to interpret histopathologically and are subject to sampling error. Our study examines outcomes for patients with a negative prostate biopsy performed for rising prostate-specific antigen (PSA) levels after prostate radiation. We performed a retrospective review of 238 prostate cancer patients with a negative biopsy following definitive radiotherapy. Seventy-five of these patients had biochemical recurrence at the time of biopsy. A negative biopsy was defined as the absence of prostate cancer without radiation-treatment effect in the specimen. Patients underwent biopsy at a mean of 41 months after the completion of radiation. They had a mean PSA of 6. Patients were followed for an average of 63 months. Thirty-two patients (43%) developed metastasis, and 11 (15%) died of prostate cancer despite a negative post-radiation biopsy. Five of nine patients (56%) with sequential biopsies had a positive second biopsy. Patients with PSA recurrence and a negative post-radiation biopsy have a high chance of persistent local disease, progression, and death from prostate cancer. Furthermore, an initial negative biopsy does not rule-out local recurrence. Patients with biochemical recurrence after radiotherapy for prostate cancer need to be evaluated earlier for local recurrence.
Highlights
Biochemical recurrence after radiotherapy for prostate cancer occurs in approximately 10-60% of patients and varies depending on definition of recurrence, tumor stage and grade at the time of diagnosis, dosage of radiation, and the use of adjuvant hormonal therapy [1]
Our study is the first, to our knowledge, to examine outcomes for patients with a negative prostate biopsy performed for biochemical recurrence after radiation
We performed a retrospective review of 238 prostate cancer patients in a prospectively maintained prostate cancer database who had a negative prostate biopsy following definitive radiotherapy between January 1st, 1992 and December 31st, 2005
Summary
Biochemical recurrence after radiotherapy for prostate cancer occurs in approximately 10-60% of patients and varies depending on definition of recurrence, tumor stage and grade at the time of diagnosis, dosage of radiation, and the use of adjuvant hormonal therapy [1]. Salvage therapy for persistent local disease after radiotherapy has shown greatest efficacy for biopsy-proven local recurrence with low prostate-specific antigen (PSA) level, and negative metastatic evaluation [2]. Post-radiotherapy prostate biopsy to detect persistent local disease is difficult to interpret histopathologically and subject to sampling error. Most studies have examined post-radiotherapy biopsies regardless of signs or symptoms or disease progression. Our study is the first, to our knowledge, to examine outcomes for patients with a negative. Prostate biopsy performed for biochemical recurrence after radiation
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