title: Therapeutic options for a rising PSA after radical prostatectomy.
abstract: BACKGROUND
  Radical prostatectomy is an effective primary treatment for clinically localized prostate cancer. While many patients are cured of their disease after surgery, there are still a significant proportion of men who will develop a biochemical recurrence (BCR). In this review, we detail existing treatment algorithms for this group of patients as well as future therapies that show great promise.
  
  
  METHODS
  A review of the literature was performed, and relevant, high-impact articles were identified and reviewed focusing on the treatment of men with BCR after surgery for prostate cancer. Wherever possible, we used data from randomized, controlled trials. When lacking, multi-institutional retrospective studies were utilized.
  
  
  RESULTS
  In a man with BCR, it is important to differentiate between local and distant failure to help guide treatment decision-making. In many of these men, adjuvant or salvage radiotherapy can improve local control, and in the case of salvage radiotherapy, it can improve overall survival (OS). Moreover, there are several systemic therapies available to men with gross metastases and/or castration resistant prostate cancer (CRPC) that have demonstrated a significant survival advantage as well as symptom control.
  
  
  CONCLUSIONS
  In the setting of BCR, many treatment options exist. Each modality has an effective role in the management of men with locally recurrent or metastatic prostate cancer. Furthermore, there are currently a number of effective therapies for men who progress to metastatic CRPC. In this review, we present current data detailing the role/efficacy of each therapy for a rising prostate-specific antigen (PSA) after definitive surgical therapy.
authors.affiliation: Department of Hematology/Oncology, Emory University, Atlanta, GA 30322, USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Carthon
authors.forename: David M
authors.initials: DM
authors.lastname: Marcus
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Herrel
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rossi
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
mesh_terms: D000465:Algorithms; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality / Q000628:therapy*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D011878:Radiotherapy; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen