title: Solitary recurrence of castration-resistant prostate cancer with low or undetectable levels of prostate specific antigen salvaged with local ablative radiation therapy: A case report.
abstract: Prostate cancer recurrences are usually first detected by increased levels of prostate specific antigen (PSA), and systemic therapy is often initiated if distant metastasis is confirmed. However, low or nearly undetectable levels of PSA in the modern era of ultrasensitive PSA assay may be difficult to interpret in patients with a history of prostate cancer. Deciding whether to initiate additional systemic therapy in limited indolent metastatic disease while balancing the quality of life of the patient and ensuring the oncologic control of the disease may be challenging. In the present study, the case of a biopsy-confirmed solitary spine recurrence of prostate cancer with nearly undetectable but persistent levels of PSA (0.05 ng/ml) is reported. Treatment of the recurrence with local ablative radiotherapy improved the pain experienced by the patient, and reduced his levels of PSA to undetectable limits (<0.05 ng/ml). Repeated imaging analysis, PSA assay and clinical assessment demonstrated durable control of the disease without the requirement for additional systemic treatments. The present case highlighted the importance of initiating appropriate work-up according to the clinical scenario. Local treatment for solitary or oligometastatic recurrence of prostate cancer may enhance the effectiveness of current therapeutic strategies and benefit certain patients.
authors: Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA.
authors: Chiachien Jake
authors: CJ
authors: Wang
authors: Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA.
authors: James
authors: J
authors: Ying
authors: Department of Pathology, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA.
authors: Payal
authors: P
authors: Kapur
authors: Department of Neurosurgery, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA.
authors: Bryan
authors: B
authors: Wohlfeld
authors: Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA.
authors: Claus
authors: C
authors: Roehrborn
authors: Department of Radiation Oncology, Texas Oncology, Waco, TX 76712, USA.
authors: Dong W Nathan
authors: DW
authors: Kim
keywords: oligometastasis; prostate cancer; salvage therapy; stereotactic body radiotherapy; undetectable prostate specific antigen