Clinical and biochemical follow-up after radiation therapy for localized prostate carcinoma

Serum PSA is an excellent marker of disease status after external beam radiotherapy or brachytherapy for patients with prostate carcinoma. A low PSA nadir ≤1 even ≤0.5 ng/mL has been shown to be as a surrogate end point for disease control. Three successive increases of this marker after achieving the nadir defines recurrence as recommended by the American Society for Therapeutic Radiology and Oncology. The biochemical relapse or PSA failure after treatment precedes clinical disease relapse by several months. PSA profile or kinetics may have implications for patterns of failure and prognosis. Prostate post- radiotherapy biopsies should not be part of routine follow-up as its interpretation is frequently problematic. Other exams should not be performed unless clinical symptoms are present. Post-radiotherapy relapse treatment has generally no curative intent. (author)