Treatment of local progression following radiotherapy

The outcome of radiotherapy for localised prostate cancer has improved over past years due to improved radiation techniques resulting in the possibility of delivering higher doses to the prostate and, secondly, due to more precise patient selection. However, there are still many men in follow-up that have been treated with radiotherapy doses which are nowadays considered as insufficient. Although improved staging and patient selection is possible, it is estimated that following surgery or radiotherapy for localised prostate cancer, approximately 40% of men will fail and present with a prostate specific antigen (PSA) relapse (biochemical recurrence) [1]. Since published results of phase III trials, randomising patients with high-risk prostate cancer between radiotherapy alone or radiotherapy plus neoor adjuvant androgen deprivation therapy, have reported improved survival for the combined approach, these high-risk patients are, in most instances, now treated in first-line with this combination for a period of time up to 3 years [2,3]. Although improved survival rates were accomplished with this combined treatment, a considerable number of patients will still experience a biochemical relapse. The most important issue in case of a demonstrated PSA relapse is the determination of local disease only or distant failure, which has to be approached in a different way. Following radical prostatectomy, several factors are helpful in defining patients at risk for local recurrence or metastatic disease e.g. time between surgery and PSA relapse, PSA doubling time, and pathological stage and grade [4]. For radiotherapy, these discriminative, predictive factors have not been identified.