title: Biochemical failure as single abnormality in patients with prostate cancer following radical treatment with external radiotherapy: follow-up without immediate treatment.
abstract: BACKGROUND
  Biochemical failure has been defined as 3 consecutive increases in PSA following curative treatment of prostate cancer. The appropriate management in such cases is controversial. The most usual treatment has been early introduction of hormones. Such patients will live for many years and hormone therapy causes important secondary effects and increases costs. The guideline in our Department of Radiotherapy has been to follow up, with no initial therapy, cases with low PSA and short PSA doubling time. The present study reports this experience.
  
  
  METHODS
  528 patients with localized prostate cancer were treated by radical approach between 1992 and 1999, with external radiotherapy, with or without adjuvant hormone therapy. After a median follow-up of 77 months, there were 207 (39%) cases with biochemical failure, 78 of which were followed without therapy after the identification of biochemical failure. All of them were asymptomatic patients and had negative radiographic examinations or did not have imaging exams requested since they presented a favorable outcome. The follow-up included at least 2 annual visits with physical examination and PSA.
  
  
  RESULTS
  Of the 78 patients with biochemical failure followed without initial therapy, 7 died from other causes than prostate cancer and the remaining 71 cases were alive and asymptomatic in the last follow-up. Prognostic factors previous to radiotherapy such as stage and Gleason score were not considered when deciding for follow-up without initial therapy in these cases. The most significant aspects considered for this decision were low PSA value (median PSA on the last visit for the 78 cases was only 3.9 ng/mL) and a slow PSA doubling time (in the present experience the median PSA doubling time was 22.5 months).
  
  
  CONCLUSIONS
  There seems to be space for expectant management, without initial hormone therapy, in patients with prostate cancer who present biochemical failure and are asymptomatic after radical external radiotherapy. This decision is important, since early introduction of hormones brings late effects and is expensive. Prospective and randomized studies are required to define this issue.
authors.affiliation: Department of Radio Oncology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada. sergio.faria@muhc.mcgill.ca
authors.forename: Sergio L
authors.initials: SL
authors.lastname: Faria
authors.forename: Mohamud
authors.initials: M
authors.lastname: Salah
authors.forename: Marc
authors.initials: M
authors.lastname: David
authors.forename: Luis
authors.initials: L
authors.lastname: Souhami
authors.forename: Marie
authors.initials: M
authors.lastname: Duclos
authors.forename: George
authors.initials: G
authors.lastname: Shenouda
authors.forename: François
authors.initials: F
authors.lastname: Deblois
authors.forename: Christian
authors.initials: C
authors.lastname: Janick
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Freeman
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen