"The groundwork of all happiness is health." - Leigh Hunt

Delaying treatment for PSA-only relapse poses no harm to survival in some men.

By Charlie Schmidt

After surgery or radiation therapy for prostate cancer, some men get an unpleasant surprise — a sudden increase in the extent of prostate-specific antigen (PSA), which is produced only by prostate cells. This could possibly be a very harmless signal, or it could mean that the cancer is just not completely gone and is beginning to grow again. Some men want to start out hormone therapy instantly, others are wonderful waiting for symptoms like prostate cancer to seem. In a study presented this week American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago indicates that waiting two years poses little risk to survival.

Because PSA is made only by prostate cells, there must be none within the blood after a radical prostatectomy, an operation to remove a cancerous prostate gland. There could also be a small amount of blood flow after radiation treatment, which can retain a small amount of the prostate. When a person's PSA level rises above a predetermined threshold but has no symptoms or other clear evidence of cancer, he is claimed to be experiencing a PSA-only relapse, which known as a PSA-only relapse. Sometimes called biochemical relapse. Doctors have traditionally treated these men with hormone therapy to starve the prostate cancer cells of proliferating testosterone. The downside is that hormone therapy has significant unwanted effects, including difficulty getting or maintaining an erection, hot flashes, fatigue, or breast tenderness or pain.

Because the reason for an increase in PSA after treatment is just not at all times known, and since hormone therapy has unwanted unwanted effects, waiting before starting may make sense for some men. There are currently no widely accepted guidelines for when to start out hormone therapy among the many 60,000 American men who only have PSA repeats annually.

The principal shortcoming of the study is that men weren't randomized to either approach. That means differences between the 2 groups can have influenced the study's results, though Garcia-Albenz said efforts were made to manage for that possibility.

Dr. Clifford Hodes, president of ASCO and chief of the breast cancer service at Memorial Sloan Kettering Cancer Center in New York, said the study provides much-needed evidence that delaying treatment could also be protected. Men with PSA alone and their doctors should take these results into consideration when deciding whether to start out hormone therapy, he said.

But Garnick cautioned against a one-size-fits-all approach. Urgent hormone therapy is warranted if relapse occurs soon after initial treatment, if PSA levels begin to double rapidly, or if the person initially has advanced, high-grade prostate cancer and PSA levels are low. Treatment may either never be detected or may begin to extend. Short time after surgery. “In these cases, I prefer to start hormone therapy early,” Garnick said.