The growth of the dog and the PSA doubling time of cancer recurrence after radical prostatectomy

What is the normal level of PSA after radical prostatectomy?

PSA, or prostate specific antigen - a tumor marker is detected in human serum. PSA is of great importance in the diagnosis of cancer and BPH. Control tumor marker after prostatectomy performed allows time to detect recurrence of the disease and to take all measures to prevent serious complications.

PSA - a protein complex secreted by prostate cells

The biological role

PSA is a complex protein consisting of 237 amino acids. Normally, the protein is synthesized in the cells of the prostate gland.

Producing in the excretory ducts of the prostate, PSA is part of her secret, and gets into sperm. The blood penetrates very small amount of protein.

The growth of PSA in serum indicates the development of the pathological process and requires a mandatory consultation of the doctor.

The main role of PSA - semen liquefaction. Due to the presence of this protein and other enzymes ejaculate becomes a medium suitable for the existence of sperm. A small amount of PSA produced by the prostate and is: in lacunar and mammary glands.

Norm

The serum PSA is in the free and bound state. Up to 90% of the antigen associated with other peptides, which makes it accessible for laboratory diagnostics. Bound and free antigen together make up total PSA, the identification of which is of great importance in practice androloga.

The concentration of PSA in the blood varies with age. PSA is considered to be the norm in the blood concentration of less than 4 ng / ml. In men younger than 50 years and more protein concentration of 3 ng / ml - disturbing symptom. The definitive diagnosis can be established only after a full examination of the patient.

Increasing PSA concentration observed fracture gematoprostaticheskogo barrier and in contact with the protein in blood. This phenomenon occurs in the following situations:

the PSA test prescribed in suspected cancer or BPH, and for monitoring the treatment. The increase in the level of protein in the blood is an unfavorable sign and requires special attention of specialists.

PSA control

Radical prostatectomy is often used to treat prostate tumors - complete removal of the prostate. Postoperatively, the patient is established a special monitoring. To evaluate the effectiveness of the treatment and early detection of metastases is controlled at a certain level of PSA scheme:

• the first analysis - 3 months after prostatectomy;
• every 6 months for 2 years;
• once a year for 5 years.

PSA sample is taken from a vein. To obtain reliable results should follow certain rules:

1. Blood surrenders morning fasting (at least 4 hours of fasting).
2. For 2 days before delivery of the analysis it is necessary to abstain from ejaculation.
3. 2 hours before the analysis can not smoke.
4. PSA level should be determined 7 days after rectal examination, TRUS or prostate massage.
5. It is not recommended to combine a survey recently carried out (6-7 days), prostate biopsy, colonoscopy, cystoscopy.
6. Taking certain drugs affect the PSA level. When the need for constant medication should notify your doctor.

Decoding results

Normal PSA following radical prostatectomy - not higher than 0.2 ng / ml. Some sources indicated that PSA is considered permissible concentration to 0.4 ng / ml.

The growth of PSA following prostatectomy indicates a recurrence of the disease. an additional examination is performed to confirm the diagnosis (ultrasound, scintigraphy, PET-CT et al.).

there are some patterns of hobbies PSA:

• The increase in PSA within 6-24 months after prostatectomy suggests systemic recurrence and occurrence of distant metastases.
• PSA growth in 2 years or more suggests the local recurrence of the disease.

HIPS - Another important indicator, allowing to reveal recurrence of cancer. PSA doubling time is directly related to the rate of tumor growth.

In the systemic relapse antigen doubled for 6-8 months, when the local - for 1 year.

Rapid growth HIPS indicates a low-grade tumor or a significant prevalence of the process and is a poor prognostic sign.

PSA - a valuable marker of the prostate. Determining the concentration of antigen in the blood allows time to detect cancer and other prostate diseases at early stages. Control PSA following radical surgery makes it possible to judge the effectiveness of the therapy and increases the chances of a favorable outcome.

Recommended viewing:

A source: http://MenQuestions.ru/urologiya/psa-posle-radikalnyy-prostatektomii.html

Prostate cancer recurrence after surgery radical prostatectomy

Malignant tumors of the prostate gland - one of the most common neoplasm in men of advanced age.

The statistics say that one in seven-eight men over 75 years of detecting prostate cancer. The disease occurs in younger men.

In the early stages of cancer diagnosed as accidental find (when trying to detect other pathology) or during routine inspection and instrumental diagnostics.

After verification of the diagnosis the doctor suggests treatment strategy. As a rule, I-II stage, the choice falls on the surgery - radical prostatectomy (Removal of the prostate tissue with the primary focus, and the seminal vesicles and regional lymph nodes). Unfortunately, even the success of the operation does not guarantee the absence of recurrence of the process in the near or distant future.

For the first 5 years after the removal of diseased prostate with the need for anti-treatment faced by 16-35% of men. The risk of recurrence of malignant neoplastic process in the first 10 years after the implementation of radical prostatectomy in the range of 27-53%.

Outdated criteria for the emergence of a new hotbed of prostate cancer took mass lesion, detected by palpation.

New standards indicate that a sign of recurrence is increasing PSA concentrations from 0.2 ng / ml and above, lockable in two or more assays.

After analyzing the concentration of PSA, it is important to understand what is the nature of a relapse. Resumption of malignant growth can be local or generalized.

Studies to determine the level of prevalence of relapse:

• TRUS prostate;
• MRI of the pelvic organs;
• CT of the retroperitoneal space;
• CT pelvis;
• PAT;
• osteostsintigarfiya;
• taking a biopsy sample from zone urethrovesical anastomosis.

Typically, palpation of the prostate tumor at a low concentration of PSA (values ​​close to zero) has no diagnostic value. Imaging (computer or Magnetic Resonance Imaging) and scintigraphy when the first signs of tumor growth also maloinformativny.

A positive result of scintigraphy is typically less than 5% provided that PSA below 40 ng / ml. Local recurrence successfully fixed in the implementation endorectal MRI (up to 81% of cases). Well proven positron emission tomography (PET).

An effective method of detection is a malignant growth scintigraphy using antibodies to the prostatic membrane antigen. This technology makes it possible to find a new malignant lesions in 60-80% of patients.

The study of prostate tumor biopsy confirms the neoplastic process in 54% of cases. If the PSA concentration is less than 0.5 ng / ml to detect cancer cells is obtained only in 28%. Based on this histological study is inappropriate, optimally focus on the growth characteristics of the PSA.

The criteria by which differentiates locally advanced cancer recurrence by generalization:

• time after the implementation of radical prostatectomy, for which there was an increase in PSA concentration;
• time period after radical prostatectomy, required for doubling the concentration of PSA;
• level of differentiation of atypical cells (Gleason score);
• tumor stage according to the TNM classification.

Indicators pointing to a local center for prostate cancer:

• PSA concentration in excess of 0.2 ng / ml, detected after at least three years after a radical prostatectomy;
• the period required for a PSA doubling the concentration is at least 11 months;
• Gleason score is not greater than 6;
• cancer stage not higher T3a.

Indicators showing cancer generalization:

• PSA levels increased significantly one year after surgery;
• for PSA doubling serum requires no more than six months;
• Gleason 8-10 index;
• T3b stage of cancer.

For treating physicians use the so-called life-saving procedure.

These include:

• conducting salvage radical prostatectomy;
• conducting salvage external beam radiotherapy;
• holding HDR brachytherapy;
• implementation of cryoablation;
• implementation of HIFU-therapy.

When radiotherapy dose of 64-66 Gy to the prostate bed remote. The result of this treatment is directly related to PSA levels recorded at diagnosis and early intervention.

If the antigen concentration did not exceed 0.2 ng / ml, a five-year survival rate is at a level of 77%. If the PSA level was 0.2 ng / ml after 5 years were still alive 34% of patients.

Radiation therapy is meaningless when the content of the antigen at a level of 1 ng / mL: 5 years later, all patients died from the consequences of relapse.

Good results show the use of radiation therapy after HIFU-therapy: five-year disease-free survival reached 64% level. Often followed by radiation therapy, doctors suggest to conduct a new operation, called salvage radical prostatectomy.

This intervention is considered could be hard and paired with the emergence of a number of complications:

• forming a stricture (narrowing) urethrovesical anastomosis is observed up to 26% of cases;
• trauma rectum during the operation (up to 2%);
• loss of control of the bladder sphincter (incontinence) occurs before 56% of episodes;
• acute urinary retention (up to 10%);
• joining a secondary infection (up to 2%).

Performance of salvage radical prostatectomy, associated with recurrent prostate cancer, it may be appropriate after the implementation of HIFU-therapy or after cryoablation.

The use of HDR brachytherapy is justified under the following indications:

• not obstructive urination;
• the period required for doubling the PSA level, more than six months;
• Gleason index of no more than 6 points;
• maximum concentration of PSA is 10 ng / ml;
• the predicted life expectancy of at least 5 years.

HDR brachytherapy upon detection of new cancer hearth performed after continuous brachytherapy or after external beam radiotherapy.

The most common are the following complications:

• acute urinary retention (14%);
• detecting erythrocytes in urine (4%);
• voiding (6%);
• damage to the rectum (4%);
• occurrence of bleeding from the rectum (2%).

Implementation saving cryoablation preferably in the following indications:

• cancer stage not higher T2c;
• score Gleason score less than 7;
• at the time of application of PSA teletherapy content does not exceed 10 ng / ml;
• prostate volume not exceeding 20-30 ml.

Under these conditions, the survival rate for 5 years up to 59%. Cryoablation easily accomplished body volume greater than 40 ml, seminal vesicle invasion.

Possible complications:

• loss of control over the sphincter of the bladder (urinary incontinence);
• delay separation of urine;
• fistula formation;
• sore crotch area;
• necrosis of the urethra, if history is listed transurethral resection of the prostate.

Salvage HIFU-therapy is not used in the case of obstructive voiding, and transurethral resection of the preceding is not an obstacle for interference. The rest of the readings are similar to those for cryoablation.

Complications of the procedure carried out after radiation therapy:

• urinary retention;
• fistula formation;
• urinary incontinence;
• luminal narrowing of the urethra;
• formation of sclerosis in the bladder neck.

HIFU-therapy is also carried out after radical prostatectomy and brachytherapy. The use of hormones.

If prior to the surgery for prostate cancer, the PSA level was 20 ng / mL, the amount of points Gleason at least 7, and the tumors are locally advanced, the advisability of hormonal drugs.

In practice oncourological applied antiandrogens combined hormone used bicalutamide in the absence of distant tumor screenings. Also, your doctor may recommend surgical castration.

Dynamic observation doctor may suggest the following conditions:

• level of differentiation of tumor cells is not higher than 7 Gleason score;
• PSA level began to rise at least 24 months after radical prostatectomy performed for primary prostate cancer.

Metastasis occurs on average 8 years of changes in the blood levels of antigen. The death of a patient for cancer comes even after the lapse of 5 years (average).

A source: https://kaklechitprostatit.ru/vidy/retsidiv-raka.html

Dog after radical prostatectomy: the rate and rate increase

Norma PSA (prostate-specific antigen) after removal of the prostate cancer is a subject of observation oncologists, urologists specialists.

This laboratory parameter study at 3 months after surgery, then every six months for 2 years, then - every year.

Consider why you need the research, what is the rate of PSA after removal of the prostate cancer and PSA levels after radical prostatectomy, which means increased results.

Why research is conducted

PSA - a protein enzyme type, which mainly produces the prostate gland, very little - other glands (lacunar, dairy). For this reason, such an antigen defined in the venous blood, according to specific marker of prostate cells. this marker normal content varies in different age periods of life of men is:

• 40-49 - 2.5 ngml.
• 50-59 - 3.5 ngml.
• 60-69 - 4.5 ngml.
• Over 70 years - to 6.5.

In prostate cancer, the level of the enzyme can be increased many times over, the PSA is often higher than 20 units. If the PSA value is up to 10 pcs., Just express suspicion for cancer, but at inspection may be BPH (benign prostatic hypertrophy), prostatitis, some other disease.

The normal PSA levels after radical prostatectomy operations is 0.2-0.3 ngml (after 3 months), then, must not rise above 0.7 ngml.

This means that the probability of proliferation of tumor cells or recurrence of the prostate cancer is very small (organism has a negligible amount of cells producing the "prostate" antigen).

Increased levels of antigen after radical prostatectomy can mean a malignancy that requires the treatment. It has a value of the time of appearance of growth of enzyme levels, especially PSADT time index value.

With high numbers of laboratory value for the first year of follow-up after surgery for prostate tumors (radical prostatectomy) detecting distant malignant growths cells.

If the marker level began to increase after 2 and more than a year after surgery, greater than the probability of occurrence of the tumor at the site of its removal (relapse).

PSA is the reason the search growth of metastases beginning treatment with hormonal or radiation therapy.

Complete removal of the prostate is the most effective method of treatment and prolongs the life of men by an average of 13 years.

How to look for sites spread or recurrence of the tumor

Distant metastases after surgery for removal of the prostate cancer (prostatectomy) may be expected for the first year of observation of the patient. This cancer foci of individual cells, separated the blood into other tissues, organs. Most often discover pockets of growth of tumor tissue in the following areas:

If radical prostatectomy was made with 3 stages of cancer, male refused radiotherapy, Hormone therapy is not administered immediately after surgery, growths appear within 4-6 months after operations. Indicator blood enzyme levels do not always correspond to the prevalence of metastasis. Search for tumors, in addition to PSA, help these research methods, such as:

• Ultrasonography (ultrasound).
• CT (computed tomography).
• MRI (magnetic resonance imaging).
• PES (positron emission scanning).

Abdominal ultrasound liver tumors reveals a high degree of accuracy if their dimensions exceed 3 mm. A typical arrangement of such structures is the area of ​​occurrence of the veins in the liver tissue, early removal of major single metastases preserves organ function.

Refines the assumption that cancer metastasis hepatic biopsy (under ultrasound guidance) from the histological examination. This is done in the case of a single metastasis large. Metastasis in the lung tissue can be detected by MRI.

Large growths of tumor with destruction of bone CT reveals, at the same time there is a significant increase in the level of antigen.

After surgery for prostate cancer removal is necessary to visit a doctor and undergo inspection, in order to avoid complications!

PES method offered by some foreign clinics, such as Finland, Germany, Israel, is highly informative.

PES (more precisely, a modification method using ftorholina) reveals metastasis of prostate cancer to lymph nodes, antigen level and when the size of lymph nodes still normal.

Surgical removal of lymph nodes with metastatic lesions increases the length of life of the patient.

Consequently, the increase in PSA level before diagnosis (as it turned out, for 4-6 months) behind the appearance of tumor growths in lymph nodes. The disadvantage of laboratory diagnostics, based on the study of PSA is also nonspecific method (Enzyme levels may be elevated in prostate inflammation, benign prostatic hyperplasia, which may be combined with cancer).

The alternative to getting new contrast agents that selectively accumulate cancerous areas of the prostate. Such observations of patients with radical prostatectomy identified early recurrence or metastasis of cancer localized in the prostate.

At the same time, this technique makes it possible to distinguish between benign prostate tumors from cancer requiring removal.

Features of the analysis

Often the cause of increased numbers result for PSA analysis is breaking the rules to give blood preparation. After 3 months operation the result will be too high, since there is no complete recovery of damaged tissues. Other subtleties of delivery of the analysis:

• Need 5-7 days to abstain from sexual intercourse.
• Donating blood is recommended in the morning until 11 o'clock, on an empty stomach (8 hours do not eat, smoke).

Not recommended before donation subjected to X-ray, ultrasonic irradiation. Visit a urologist, home of the rectal digital examination, also advised after the date of analysis.

If a biopsy of any organ, the analysis should be postponed for 3 weeks. Many factors affect the result of the laboratory value in the postoperative period.

A source: http://MensGen.ru/prostate/cancer/psa-posle-radikalnoj-prostatektomii.html

What is the rate of PSA after removal of the prostate cancer?

Regular inspection after the removal of a malignant tumor reveals a relapse before the onset of clinical signs. Norma PSA after removal of the prostate cancer has no fixed boundaries. Level of a substance may vary depending applied therapies. Indicators monitor the dynamics, the recommended intervals.

What happens to the amount of enzyme after prostatectomy

The first time the blood sample was taken after 30 - 60 days after organ resection.

According to results of the analysis can not be judged on the presence of any remaining cancer cells. To assess the patient's condition test is performed at an interval:

• 1 month - if the initial results are inflated.
• 3 months - under normal terms.

A slight increase may indicate the presence of the remaining benign prostate cells.

As the enzyme level varies without operation after treatment

When the cancer is removed with the help of beams of ionizing radiation, the rapid decrease in the amount of the enzyme is not worth waiting.

To evaluate the effectiveness of treatment analyzes were performed:

• The first 2 - 3 months. The normal level is considered 0.5 ng / ml.
• Follow with an interval of 6 months, when the initial value is within the permissible values. If PSA was elevated, the patient will need to donate blood 1 time in 3 months.

On successfully completed treatment say when the level of prostate-specific antigen is gradually reduced. A few years later he approaches the normal value.

Regular increase - a bad sign, most likely the cancer cells remain and will need to repeat the treatment.

PSA indicators

The blood circulating once type 2 prostate-specific antigen:

• Free. Measured for the diagnosis of pathological processes in the prostate tissue.
• Connected. Closed to the carrier molecule, so it is impossible to estimate the amount.

PSA identify the following indicators:

• Density. It helps to distinguish benign tumors from cancer. Before it computation performed transtrektalnoe ultrasound. Displacement organ divided by the number of enzyme.
• gain speed. The most informative. It allows you to identify the early stages of oncology, to evaluate the effectiveness of treatment.

How to recognize a relapse

Prostate-specific antigen is the most informative matter, the number of which is determined traversed ineffective therapy. With an increase in other studies carried out, allowing you to confirm or refute the concern is:

• MRI or CT;
• biopsy;
• scintigraphy;
• US.

The difficulty lies in the fact that early detection of relapse is not always possible. The level of prostate-specific antigen usually increases for 6 - 48 months and the possibility of a visual estimation of tumor. MRI confirms the diagnosis in 80% of cases (sometimes detect cancer early increase in PSA), and scintigraphy is only 5%.

Previously considered a new tumor relapse could be detected by palpation. Today, with high probability for cancer PSA indicate the following figures:

• quantity;
• doubling time;
• growth rate;
• Gleason index.

The decision to start re-treatment is made based on the aggregate results.

At high rates of PSA prior to surgery, the patient is prescribed hormone therapy, reduce the likelihood of metastasis.

In cases of recurrent prostate cancer prefer anti-androgen drugs.

Periodic monitoring of prostate-specific antigen is carried out for a long time after the end of inpatient treatment. If the increase is late character, metastases can occur even after 8 years or more after surgery. Such dynamic monitoring of the patient is required.

Relapse after radical prostatectomy is observed in 25 - 50% of patients. In patients with late-rising prostate-specific antigen figure increases to 80%.

normal levels

The amount of prostate-specific antigen increases regularly. The older man, the higher its level.

After recovering from cancer radiation methods enzyme concentration should gradually return to normal values, the relevant age group. Up to 50 years is 2.5 ng / ml, and after 70 and above - 6.5 ng / ml.

Successful operation for the removal of prostate cancer is accompanied by a sharp increase in this index, and then a gradual decrease. Meet the normal age figures he will be gone.

Sometimes after removal of the prostate cancer manages to save, so after 2 years or more, PSA levels can rise with the appearance of other pathologies of the male reproductive system:

• BPH;
• prostatitis (acute and chronic exacerbation);
• ischemic lesions of the prostate;
• myocardial authority;
• prolonged absence of urination.

proper preparation

A study on the PSA (prostate-specific antigen) capable of giving false results, so before taking a blood sample set of rules must be followed:

• Blood rent fasting (8 hours before a meal).
• No smoking in 2 hours prior to analysis.
• 3 days of food is excluded severe food (fried, smoked, fat, spicy, marinated) and alcohol.
• The interval between the last ejaculation and going to the lab - 2 days.
• 48 hours before the procedure eliminated the physical and emotional stress.

A source: https://pro-rak.ru/organy/prostata/norma-psa-posle-udaleniya-raka-prostaty.html

Change in PSA levels after radical prostatectomy

prostate cancer in the early stages is very difficult to diagnose because it is masked by symptoms characteristic of BPH and prostatitis. The only way to determine the presence of malignant process begun in the prostate, is the determination of PSA which rolls in cancer. What should be the level of PSA after radical prostatectomy?

When too large adenomas or cancer in the early stages, when metastases have not yet started spread, and the tumor is localized within the affected organ, need surgery to solve the problem once and for all. Should not fear that the quality of life of the man fall after the removal of the prostate, is actually much better to remove incorrectly functioning organ, because it can greatly hurt body.

Radical prostatectomy performed if PSA indicators do not exceed 20 ng / mL, would otherwise have to use chemotherapy to reduce the level of the substance in the body. Another prerequisite for the operation is an age younger than 75 years, and an increase in life expectancy by at least 10 years after the operation.

Currently there are two ways of operation:

open prostatectomy	Laparoscopy
Is one large incision in the abdomen, about 10 cm, or small between the anus and the scrotum	It takes a few small incisions, which are placed in special equipment
A doctor in the operation manual cuts prostate	To remove the used devices may conduct transactions using a special robot, in this case, your doctor may just monitor its actions by means of manipulators
Recovery will take about a couple of weeks, the stitches will be removed after 7 days after the successful surgery	The patient can walk the very next day after the laparoscopy, rehabilitation takes a minimum of time

Select the type of operation should only doctor who will be based on the results of the survey. Open prostatectomy is advantageous in that it is possible both to remove the stones from the bladder, but it is heavier in terms of rehabilitation. Laparoscopy - a more modern method, but do not always have the necessary equipment in the clinics.

What is a PSA?

PSA stands for prostate-specific antigen and is produced, as the name suggests, the male prostate gland.

It is normally present in the body of the stronger sex constantly and is responsible for the consistency of seminal fluid and sperm protection against external influences.

But it is important not only in matters of reproduction, but also for the diagnosis of cancer process, which appeared in the prostate gland.

In the male, the PSA is in two forms:

• associated at which a substance is connected with other molecules and inactive;
• free, wherein the active PSA.

Since it is impossible to accurately calculate the total amount of PSA formed in the body, so take into account only the free form, but it is enough to determine the presence of cancer.

The rules of analysis

To analyze the result was the most significant, the following requirements prior to blood donation need to do:

• to come to the laboratory need in the morning, have breakfast at the same time is impossible;
• at least 8 hours before giving blood from a vein is necessary to refuse from sugary juices, coffee and alcohol;
• 5-7 days before the visit to the hospital is necessary to stop sex;
• if produced massage or other manipulation of the prostate, then you need to wait 3 weeks and only then to donate blood;
• If tissue samples were taken for a biopsy, you can not come to the analysis, if it's been less than a month after the procedure.

To test the PSA blood taken from a vein, an overall analysis is then performed, and the rate of prostatic agents indicated in the results. In some cases, you may need to separate the PSA test for more careful tracking of changes in its level.

normal levels

PSA does not exist a rule that would fit perfectly to all the representatives of the stronger sex. It is known that the level of the substance depends on the size of the prostate itself, which tends to increase as men get older and aging. The following normal values ​​for men of all ages:

• under 40 - less than 2.5 ng / ml;
• from 40 to 50 years - 2.5;
• from 50 to 60 - 3.5;
• from 60 to 70 - 4.5;
• older than 70 - 6.5.

But these figures may not be the same men who had surgery to remove the prostate. PSA following prostatectomy decreases sharply because the body which produces the substance is removed, so performance can be less than 0.2 ng / ml.

Leading doctors say that you should not worry if performance exceeded even the 8-10 ng / ml as the PSA in a man the body can be produced very unstable and depend not only on the presence or absence of cancer, but other factors.

Despite the fact that it is the prostate gland mainly produces prostatic substance PSA can be generated by periurethral and breast cancer. That is why, even after removal of the prostate tests indicate the presence of prostate-specific antigen.

To the result of laboratory tests was the most significant, it is necessary to donate blood as often as possible. If the values ​​do not exceed 0.2-0.4 ng / ml, and these figures are kept for a long time, the risk of recurrence are not talking. With a good recovery after surgery such figures are observed, and a year later, and after a few years.

Another thing, if the figures have again started to grow rapidly. In this case, we can talk about a relapse of cancer. If the figures have increased a few years after the operation, we can confidently talk about cancer.

Why can increase PSA performance?

In addition to oncology, the increase in PSA levels may be caused by the following reasons:

• inflammation in the urogenital region;
• trauma of the pelvic organs;
• prostate incomplete extraction, the remaining parts which continue to produce PSA;
• allergy to applied during surgery medicines;
• infection after surgery.

The increase in PSA after removal of the prostate may be associated with the spread to adjacent organs metastasis. To avoid recurrence, usually doctors prescribe special therapy, which the patient has to take the letter. Statistics says that the cancer has returned to approximately 30%, so you need to make every effort to oncology is not asserted itself again.

If, nevertheless, the disease returned, patients need to be carefully examined with the use of the most modern equipment to assess the extent of malignancy and to identify the most optimal treatment.

It is commonly used radiation therapy, treatment with hormones and chemotherapy.

Antiandrogen drugs have good effects and quite easy to carry patients, If the patient has no metastases have spread throughout the body, the risk of cancer returning significantly decreases.

The best that can be done in such a situation, the patient - monitor their condition and seek medical attention at the slightest ailments, as well as the time to donate blood. Only in this way can be time to notice the malignant processes and prevent them, thereby prolonging the life for many more years.

A source: https://UroGuru.com/terapiya/predstzhelezy/uroven-psa-posle-radikalnoj-prostatehktomii.html

Methods of salvage therapy for prostate cancer | Experimental and clinical urology

Methods of "salvage" therapy applied at local or biochemical recurrence of prostate cancer after its treatment with curative intent.

Biochemical relapse after radical prostatectomy (RP) consider two successive increase in PSA level greater than 0.2 ng / ml (Table 1). Following radiation therapy, according to criteria ASTRO - three successive increase in PSA level (Int. J. Radiat. Oncol. Biol. Phys., 1997).

Currently, the majority of experts (M. Roach, 2006) inclined to believe that, after radiation therapy (EBRT, brachytherapy) Biochemical relapse - a rise in PSA level of 0.2 ng / ml and above nadir (criteria RTOG-ASTRO).

After minimally invasive ablative techniques, which include HIFU- therapy, radiofrequency ablation (RFA) and cryoablation, according to

Biochemical relapse elevated PSA level above 1 ng / ml (Aus G., 2006).

Determination of biochemical recurrence after focal treatment is the subject of debate. So far, the consensus does not exist.

After detection of biochemical recurrence, it is necessary to answer the question: "Is this the progression of local or systemic?".

In order to confirm the nature of relapse is necessary to use all the modern means of visualization: TRUS prostate, magnetic resonance imaging prostatic and pelvic organs (MRI), computed tomography retroperitoneum and pelvis for visualization of enlarged lymph nodes,

Positron - emission tomography (PET), bone scan and biopsy of the prostate gland or after radiation techniques zone urethrovesical anastomosis after radical prostatectomy. After radiological methods and ablative technologies biopsy is expedient to carry out no earlier than 18 months after treatment.

Currently we developed certain criteria that are expected to differentiate the local progression of the generalization of the process after RP.

These criteria include: the rise time of PSA, PSA doubling time, differentiation of tumor Gleason score and pathological stage it.

For example, a local recurrence after radical prostatectomy with high probability can be judged if the PSA level rise more than 0.2 ng / ml is observed not earlier than

Three years after surgery, PSA doubling time is more than 11 months, Gleason score - less than 6, and pathological stage - less than T3a (Heidenreich A., 2010).

Local recurrence after radiotherapy can assume the detection of malignant cells in biopsies prostate after 18 months in the absence of a metastatic lesion by CT, MRI, bone scintigraphy and (Table 1).

Table 1. Local recurrence after radical prostatectomy

Criteria for differentiation of local
recurrence of generalizovannogoBolee than 80% of patients
with local progressirovaniemBolee than 80% of patients
with systemic progression

PSA rise time after the intervention	PSA rise of more than 0.2 ng / ml after 3 years	Increasing PSA levels less than 1 year after surgery
PSA doubling time	≥ 11 months	4 - 6 months
Tumor differentiation Gleason	≤ 6	8—10
Pathological stage T	≤ pT3a, pN0, pTx 1	pT3b, pTx pN1

A. Heidenreich, M. Bolla, S. Joniau, M.D. Mason, V. Matveev, N. Mottet, H-P. Schmid, T.H. van der Kwast, T. Wiegel, F. Zattoni. Guidelines on Prostate Cancer

Saving treatments for prostate cancer
For options "saving" treatment include: external beam radiotherapy, radical prostatectomy, HDR brachytherapy, cryoablation, and HIFU-therapy.

In most cases at local recurrence after radical prostatectomy performed savingexternal beam radiotherapy (64-66 Gy to the prostate bed).

It is shown that the smaller the original PSA level after radical prostatectomy performed better treatment results.

For example, if the PSA to teletherapy not exceed 0.2 ng / ml, the 5-year disease-free survival rate reaches 77%, whereas patients with a PSA level of 0.2-1.0 ng / ml, it is 34% and 0% respectively.

External beam therapy is possible and after HIFU-therapy.
According to Ward J.F. (2005) after the DLT 45 patients undergoing HIFU, 5-year survival without biochemical relapse was 64%.

Salvage radical prostatectomy (SRPE) often operate after external radiotherapy (Bianco F.J. Jr., 2005). Five-year vyzhivaemostbez biochemical recurrence after salvage radical prostatectomy kolebletsyaot 47 to 65% ten-year survival rate - 30-43%.

Five-year cancer survival rate is 90-93% of 10 year old - 70-77%.

The probability depends on disease progression PSA before saving RP: the level of PSA less than 4 ng / ml of free survival Biochemical relapse was 86%, whereas in PSA 4-10ng / ml and more than 10 ng / ml, 55% and 37%, respectively (Gotto G.T., 2010).

Technically perform RPE after radiotherapy hard enough, so the complication rate after it is significantly higher than after the initial radical prostatectomy.

Among the most frequent complications (Table 2) according to Gotto G.T.

(2010) after SRPE include: urethrovesical anastomotic strictures (up to 26%), damage to the rectum (1-2%), urinary incontinence (56%), acute urinary retention (up to 10%), infectious complications (2%).

Table 2. Complications after prostatectomy and SRPE

OslozhneniyaPosle SRPEPosle RPE

Urethral stricture-vesical anastomosis	1-26%	0,2-3%
Damage to the rectum	1-2%	0%
Urinary incontinence	56%	43%
Acute urinary retention	1-10%	0,2-0,3%
infectious complications	2%	0%

Geoffrey T. Gotto, 2010

Salvage radical prostatectomy can be and after HIFU-therapy. Lawrentschuk N. (2011) published the results of the implementation of saving 15 RP patients.

The mean follow-up in this study for 16 months, during which in 14 men PSA level did not exceed 0.2 ng / ml.

However, in one patient, which was observed for 24 months was observed PSA level above 0,2 ng / ml, which necessitated performing adjuvant radiotherapy.

Salvage radical prostatectomy is possible in the case of local recurrence after cryoablation of the prostate gland. In the literature, there is a message of 6 patients who underwent radical prostatectomy saving (Grampsas S.A., 1995). The authors note that in
12 months of observation, all patients were alive and disease progression was absent in the level of PSA (PSA less than 0.2 ng / ml).

Salvage HDR brachytherapy (SVBT) It may be performed after external radiotherapy and brachytherapy permanent. By indications include: obstructive type of urination; PSA doubling time of more than 6 months; Gleason score less than or equal to 6; PSA levels less than 10 ng / ml; while life expectancy of more than 5 years.

Five-year survival without biochemical relapse after the SVBT patients undergoing ESWL It amounted to 34-38%, and after permanent brachytherapy - 54% (Grado G.L., 1999, H. K. Lee, 2008, Burri R.J., 2010).

Complications most frequently encountered in this form of treatment are: acute delay urination - 14%, hematuria - 4%, dysuria - 6%, the damage of the rectum - 4%, rectal bleeding - 2%. (Grado G.L., 1999, Lee H.K., 2008, Burri R.J., 2010).

Salvage cryoablation submitted after DLT "ideal
hydrochloric "for patients with clinical stage T2c less; Gleason score of less than 7, PSA less than 10 ng / ml at the time of execution of DLT. The "ideal" amount of the prostate gland to perform cryoablation: 20-30 cm3. Five-year survival without biochemical relapse is 59% (Table3).

Table 3. The results of cryoablation after EBRT (Mohamed Ismail, 2007)

AvtorKoli- honors

patients

Medina
follow-up (months). assessment threshold biohi-
nomic retsidivaVyzhivaemost without biochemical relapse (%)

low risk

Medium risk riskVysoky

de la Taille et al.

43

22 (1-54)

A source: http://ecuro.ru/article/metody-spasitelnoi-terapii-raka-predstatelnoi-zhelezy