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Definition |
Similar to patients experiencing PSA-recurrence after RP, patients with a PSA-rise following RT can be subdivided into prognostic categories. A high-risk subgroup with elevated risk of metastases and PCSM are those patients with a PSA-DT < 3 months, time to biochemical progression < 3 years, biopsy Gleason score 8-10 and clinical stage cT3b-T4. Conversely, patients at low risk of metastases and PCSM are those with a PSA-DT > 15 months, biopsy Gleason score < 7, clinical stage < cT3a and time to biochemical progression> 3 years. Zumsteg et al. have designed a risk score to further subdivide patients who develop PSA recurrence following RT. Those with either 0, 1 or > 2 high-risk factors (PSA-DT < 3 months, time to biochemical progression < 3 years, biopsy Gleason score 8-10 and clinical stage cT3b-T4) have an increased risk of developing metastases and PCSM.Again, the choice of local salvage treatment (salvage RP, salvage cryo, salvage HIFU, salvage brachytherapy)should be guided by the life expectancy and oncological risk profile of each patient, together with the patient’s expectations.
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