ABSTRACT
The use of prostate-specific antigen (PSA) screening in conjunction with digital rectal examination (DRE) and transrectal ultrasound (TRUS) has resulted in earlier cancer diagnosis and increased opportunities for cure. Nevertheless, disease recurrence after local therapy for prostate cancer is increasingly common. In part this is due to clinical understaging of the cancer, which occurs in up to 50% of patients undergoing radical prostatectomy, although the contemporary incidence is likely closer to 20%.1,2 An analysis of patients enrolled in a disease registry of prostate cancer patients demonstrated that 22% of patients who received initial treatment with radical prostatectomy, radiation therapy, or cryotherapy required a second form of prostate cancer treatment within 3 years of initial therapy.3 Most of these treatments were administered in a nonadjuvant (therapeutic) fashion for apparent evidence of disease recurrence. Patients managed with radical prostatectomy had the lowest rate of second cancer treatment. Similar results have been reported by others, with at least 16% to 35% of radical prostatectomy patients and 24% of radiotherapy patients receiving second cancer treatments within 5 years of primary treatment.4-6 Currently, failure of therapy is most often manifest solely by a rising PSA level. Moul estimated that up to 50,000 men per year may have PSAonly recurrence after definitive treatment.7 However, there are no adequate studies comparing outcomes of these secondary treatments, and the specific indications and optimal timing for additional therapy are equally undefined. Herein, we discuss the various treatment options with definitive, curative intent in patients whose cancers recur locally after radical prostatectomy, radiation therapy, or cryotherapy.
