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17.06.2014:  RISING PSA FOLLOWING RADICAL PROSTATE CANCER TREATMENT. IS THERAPY ALWAYS NECESSARY?

Most patients who have undergone radical prostatectomy or radiotherapy for early stage prostate cancer are cured. There are, however, some patients who present with a rising PSA which is a sign of relapse. Do all these individuals need treatment? Will these patients die of prostate cancer?
The answer is NO. A rising PSA means that 3 consequetive measurements of PSA every 2 months increase by 0.2ng/ml. In these cases the therapeutic options are the following:
1)Observation
2)Salvage Radiotherapy
3)Salvage Radiotherapy along with hormonal treatment
4)Hormonal treatment
5)Radical lymphadenectomy

Certainly, treatment is individualized. Treatment will be mandatory for those patients who fulfill the following criteria:
 A)Gleason score>8
 B)Doubling time of PSA<1 year (usually 6 months)
 C)Recurrence following initial treatment <1year
All other patients may not require immediate treatment.
It must be remembered that hormonal treatment is the usual initial approach with drugs. Chemotherapy can be used in later stages. Exceptionally, combination of hormonal treatment and chemotherapy is allowed in patients with visceral involvement and/or prostate cancer with Gleason score >8.