What to do for prostate cancer patients with a rising PSA?--A survey of Australian practice.
OBJECTIVE
To document current Australian management of asymptomatic prostate cancer patients with prostate-specific antigen (PSA) relapse after radical treatment or considered unsuitable for radical treatment.


METHODS
Four case scenarios-postprostatectomy PSA relapse, postradiotherapy (RT) with a slow or a rapidly rising PSA level, or no radical treatment-were presented. Management preferences, including (where relevant) RT, androgen ablation either immediate or delayed until a PSA rise or symptomatic progression, and other approaches, were identified. The preferred methods of androgen ablation were noted.


RESULTS
One hundred eighteen informative replies out of 324 e-mailed surveys were received. For postprostatectomy PSA relapse, 59% of respondents favored salvage RT. For post-RT with a slow or a rapidly rising PSA level and treatment of nonradical patients, there was no clear consensus of opinion, with respondents divided among the different options. A diverse range of PSA levels was cited for delayed intervention, with values ranging from 0.8 to 100 ng/mL. PSA doubling time proved a more consistent criterion for determining intervention. Most respondents favored the use of a luteinizing hormone-releasing hormone agonist as first-line androgen ablation, although patient choice was recognized as important in all decision making.


CONCLUSIONS
A lack of available evidence underlies the diversity of opinion regarding the management of asymptomatic prostate cancer patients with a rising PSA. The need for randomized controlled trials in this area is highlighted.
Duchesne
Gillian M
GM
Department of Radiation Oncology, The Alfred Hospital, Melbourne, Australia. gduchesne@peterma.unimelb.edu.au
Millar
Jeremy L
JL
Moraga
Vladimir
V
Rosenthal
Mark
M
Royce
Peter
P
Snow
Ross
R
D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001315:Australia; D032921:Consensus; D003657:Decision Making; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000532:radiotherapy / Q000628:therapy; D009919:Orchiectomy; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000532:radiotherapy / Q000628:therapy*; D018787:Radiation Oncology; D012008:Recurrence; D016879:Salvage Therapy; D018709:Statistics, Nonparametric; D014572:Urology
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen