NCCN Guidelines for Patients® | Prostate Cancer - page 60

60
NCCN Guidelines for Patients
®
: Prostate Cancer
Version 1.2014
Part 6: Monitoring and salvage treatment
Next steps
. Persistent cancer is cancer that is not
completely removed or destroyed by initial treatment.
Recurrent cancer is the return of cancer after a cancer-
free period. If tests suggest that there’s persistent or
recurrent cancer after radical prostatectomy, read Part
6.3. Part 6.4 describes salvage treatment after radiation
therapy.
Possible tests
6.3 Treatment after radical prostatectomy
Test results
Treatment options
After a radical prostatectomy, your PSA level should fall
to near zero since the whole prostate was removed. If this
doesn’t happen, it may be a sign of persistent cancer. If
tests find that your PSA level increases twice in a row after
falling to near zero, the cancer may have returned.
Since high PSA levels don’t always mean persistent or
recurrent cancer, tests that find distant metastases may
be done. A CT, MRI, or TRUS is used to look for cancer
spread to lymph nodes or other organs. A fast PSA
doubling time is a sign of aggressive cancer with possible
spread to the bone. A bone scan shows if the cancer has
spread to the bone. It is usually done when there are
symptoms of bone metastases or when your PSA level
is rising quickly. If imaging tests suggest there’s cancer
near to where the prostate was, a biopsy can be used to
confirm if cancer is present.
If there is little reason to suspect distant metastases,
radiation therapy with or without long-term ADT is
recommended. However, observation may be a better
choice depending on your overall health and personal
wishes. For ADT, an LHRH antagonist or LHRH agonist
may be used. However, doctors often use CAB. If you
will receive ADT, it will be given before, during, and after
radiation therapy.
For known or highly suspected distant metastases, ADT is
the main treatment. Radiation therapy may also be used to
Metastases
• PSA doubling time
Possible tests:
• CT, MRI, or TRUS,
• Bone scan,
• PET scan, or
• Biopsy
No metastases
Observation
ADT ± EBRT
Observation
EBRT ± ADT for 2–3 years, or
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