Pretreatment Gleason score, clinical stage, PSA level, and percentage of positive core biopsy results have been found to be reliable predictors of failure after local therapy. Unfortunately, no means of identifying recurrences limited to the pelvis is reliable. Although a Gleason grade of 7 or less is associated with a better prognosis than a grade of 8 or more, if the PSA level rise occurs after 2 years after local treatment, the associated survival likelihood is greater than if the rise occurs before 2 years. In general, after radical prostatectomy, the PSA level should be < 0.2 ng/mL, and after radiation therapy, it should be < 0.5 ng/mL.
No guidelines have been set for treating patients with advanced prostate cancer in whom local therapy has failed. A balance between disease control and minimization of the toxicity and intolerance of the treatment is difficult to maintain. Although androgen-deprivation therapy can limit disease progression and reduce urinary outlet obstruction, it produces adverse effects and increases the risk for anemia, hot flashes, gastrointestinal tract disturbances, loss of libido, impotence, osteoporosis, muscle wasting, gynecomastia, deep vein thrombosis, congestive heart failure, myocardial infarction, pulmonary edema, and psychological changes.
Therapeutic options include the following:
Luteinizing hormone-releasing hormone (LHRH) agonists: offered in 1-month, 3-month, and once-yearly depots
Combined androgen blockade: LHRH agonist with an oral antiandrogen
Monotherapy of nonsteroidal antiandrogens (eg, bicalutamide)
Gonadotropin-releasing hormone agonist
For more on the treatment of advanced prostate cancer, read here.
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Cite this: Bradley Schwartz. Fast Five Quiz: Test Your Knowledge of Advanced Prostate Cancer - Medscape - Nov 16, 2017.
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