Management of PSA Relapse

Case 4: Rising PSA after radical prostatectomy

Case 4: Rising PSA after radical prostatectomy

If you were going to administer radiation therapy and hormonal therapy to this patient, what would be the duration of the hormonal therapy?

If you were going to administer radiation therapy and hormonal therapy to this patient, what would be the duration of the hormonal therapy?

Case 5: Rising PSA after prostatectomy and radiation therapy

Case 5: Rising PSA after prostatectomy and radiation therapy

Case 5: Rising PSA after prostatectomy and radiation therapy

Case 5: Rising PSA after prostatectomy and radiation therapy

Case 6: If PSA doubling time in the previous case was 6 months, would this change your recommended therapy?

How would this change your recommended therapy?

How would this change your recommended therapy?

How would this change your recommended therapy?

How would this change your recommended therapy?

Case 7: Rising PSA after primary androgen deprivation

Case 7: Rising PSA after primary androgen deprivation

Case 7: Rising PSA after primary androgen deprivation

Case 7: Rising PSA after primary androgen deprivation

In general, for a patient with a rising PSA, do you use PSA doubling time or PSA velocity to determine when to initiate or recommend treatment?

What percent of your patients who undergo radiation therapy for prostate cancer experience “PSA bounce”/benign rise?

How long do you wait after radiation therapy before reevaluating PSA level?

I usually initiate hormone therapy concurrently with salvage radiation therapy in a patient with a biochemical recurrence after prostatectomy.

I usually initiate hormone therapy concurrently with salvage radiation therapy in a patient with a biochemical recurrence after prostatectomy.

In general, after radical prostatectomy, what PSA is your threshold to initiate or recommend some type of treatment?

In general, for patients more than one year after radiation therapy, what PSA is your threshold to initiate or recommend salvage treatment?

For a patient with Stage 1c, PSA 12, Gleason 7 prostate cancer who underwent radical prostatectomy two years ago with a nondetectable postoperative PSA and now has a PSA of 0.3 ng/mL, at what point would you refer him for salvage radiation?

If you suspect “PSA bounce”/benign rise, do you treat the patient with either antibiotics or an anti-inflammatory?

If you were diagnosed with PSA-only relapse two years after a radical prostatectomy that required hormone therapy and you had good erectile function at that point, which treatment would you likely prefer?

If you were diagnosed with PSA-only relapse two years after a radical prostatectomy that required hormone therapy and you had good erectile function at that point, which treatment would you likely prefer?

If you were diagnosed with PSA-only relapse two years after a radical prostatectomy that required hormone therapy and you had minimal erectile function, which treatment would you likely prefer?

If you were diagnosed with PSA-only relapse two years after a radical prostatectomy that required hormone therapy and you had minimal erectile function, which treatment would you likely prefer?

If you were diagnosed with prostate cancer that recurred after local therapy and then progressed through hormone therapy — as PSA-only relapse with a 3-month doubling time — how likely would you be to receive chemotherapy?

If you were diagnosed with prostate cancer that recurred after local therapy and then progressed through hormone therapy — as PSA-only relapse with a 3-month doubling time — how likely would you be to receive chemotherapy?

Clinical trials will eventually demonstrate that chemotherapy is effective in PSA-only disease either alone or with androgen deprivation in reducing the rate of clinical progression.

Clinical trials will eventually demonstrate that chemotherapy is effective in PSA-only disease either alone or with androgen deprivation in reducing the rate of clinical progression.

How likely would you be to recommend that a patient enter a clinical trial designed for patients with PSA-only disease, randomly assigned to either chemotherapy or no chemotherapy (with or without hormone therapy)?

How likely would you be to recommend that a patient enter a clinical trial designed for patients with PSA-only disease, randomly assigned to either chemotherapy or no chemotherapy (with or without hormone therapy)?

It is reasonable to offer chemotherapy in a clinical setting to some patients with PSA-only relapse whose disease has become refractory to hormone therapy.

It is reasonable to offer chemotherapy in a clinical setting to some patients with PSA-only relapse whose disease has become refractory to hormone therapy.

Ketoconazole should be administered prior to chemotherapy for a patient with androgen-independent prostate cancer (M0) based on a rising PSA level only.

Ketoconazole should be administered prior to chemotherapy for a patient with androgen-independent prostate cancer (M0) based on a rising PSA level only.

Ketoconazole should be administered prior to chemotherapy for a patient with androgen-independent prostate cancer associated with progressive bone metastases.

Ketoconazole should be administered prior to chemotherapy for a patient with androgen-independent prostate cancer associated with progressive bone metastases.

Would you offer a consultation with a medical oncologist to a patient with PSA-only disease who has progressed on two forms of hormone therapy and is considered hormone resistant and now has a PSA doubling time of 3 months if the patient’s age was: (Percent answering yes)

Would you offer a consultation with a medical oncologist to a patient with PSA-only disease who has progressed on two forms of hormone therapy and is considered hormone resistant and now has a PSA doubling time of 3 months if the patient’s age was: (Percent answering yes)

In general, all patients with PSA-only relapse prostate cancer should have a consultation with a medical oncologist at some point in the process of making a decision on a specific clinical course or treatment.

In general, all patients with PSA-only relapse prostate cancer should have a consultation with a medical oncologist at some point in the process of making a decision on a specific clinical course or treatment.

I have concerns about referring my patients to a medical oncologist because the patients may be overtreated with chemotherapy.

I have concerns about referring my patients to a medical oncologist because the patients may be overtreated with chemotherapy.

I work with one or more medical oncologists who seem to be very interested in prostate cancer.

I work with one or more medical oncologists who seem to be very interested in prostate cancer.