title: Medical treatment for biochemical relapse after radiotherapy.
abstract: This article's purpose was to review the medical data justifying the use of a medical treatment for biochemical relapse after external beam radiotherapy. The MEDLINE database was searched to identify relevant information with the following medical subject headings: "prostate cancer", "radiotherapy" and "biochemical relapse". Prognostic factors affecting the overall survival of patients with a biochemical relapse after external beam radiotherapy have been identified: short prostate specific antigen (PSA)-doubling time (< 12 months), high PSA value (> 10 ng/mL) and short interval between treatment and biochemical relapse (< 18 months). If a second local treatment is not feasible, timing to initiate a salvage medical treatment is not defined. Particularly, randomized trials did not demonstrate a significant benefit of an early initiation of androgen deprivation treatment. Some retrospective studies suggest that an early androgen deprivation is justified if poor prognostic factors are found. However, if an androgen deprivation treatment is prescribed, intermittent schedule is non-inferior to a continuous administration and seems to offer a better quality of life. Many non-hormonal treatments have also been evaluated in this setting: only 5-alpha-reductase inhibitors could be proposed in some specific situations. In conclusion, the judicious use of a medical treatment for biochemical relapse is still debated. Given the natural history of this clinical situation, a simple surveillance is justified in many cases.
authors.affiliation: Service de cancérologie-radiothérapie, Hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Quero
authors.affiliation: Service de cancérologie-radiothérapie, Hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris, France. Electronic address: christophe.hennequin@sls.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Hennequin
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000532:radiotherapy / Q000556:secondary; D000726:Androgen Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D004334:Drug Administration Schedule; D016021:Epidemiologic Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D016032:Randomized Controlled Trials as Topic; D016879:Salvage Therapy; D057832:Watchful Waiting
chemical_list: D058891:5-alpha Reductase Inhibitors; D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen
keywords: Biochemical relapse; Cancer de la prostate; Prostate cancer; Radiotherapy; Radiothérapie; Rechute biochimique