Prostatic Biopsy after Radiotherapy: When and How

Abstract

Objectives: External beam radiotherapy and seed implantation are treatment options for clinically localized prostate cancer. Post-radiation biopsies may assess the efficacy of radiation in locally eradicating prostate cancer cells. Aim of this overview was to analyze the role of prostate rebiopsies after radiation to evaluate treatment success. Methods: A Medline search was performed from 1980 to 2001 for articles in English. Results: Based on the available data a positive prostate rebiopsy can be found in 18–90% for patients with stage T1–T3. Pretreatment PSA, pretreatment Gleason score, clinical stage and digital rectal examination (DRE) after radiotherapy correlate with biopsy results. A positive post-treatment biopsy is associated with a higher nadir PSA serum level and a higher rate of local recurrence compared to patients with negative biopsies. However, systematic prostate biopsies after radiation therapy are not necessary in the standard follow-up because a rising PSA after radiation therapy is a more rigorous end-point for evaluation of treatment efficacy. However, patients with rising PSA after irradiation without evidence of systematic disease and positive prostate biopsies may be candidates for salvage treatment. Conclusions: Prostate biopsies after radiation therapy are not necessary as a standard procedure for follow-up. Prostate rebiopsies may be an important research tool to evaluate histological changes within the prostate and may indicate local recurrence.