MDT (multi-disciplinary team) guidance for managing prostate cancer

Locally Advanced (Non-metastatic) Disease:
Relapse after Primary Treatment
Figure 3: Treatment algorithm for locally advanced (non-metastatic) disease (cont.)
Is this patient suitable for clinical trial?
Post-radical prostatectomy
MANAGEMENT OPTIONS 2
Failed local Rx with rising PSA
and/or local recurrence+ Mo
Active surveillance/watchful waiting Active surveillance/watchful waiting
Hormone therapy alone Hormone therapy alone
External beam radiotherapy
(EBRT) +/– concomitant +/–
adjuvant hormone therapy
Post-radical radiotherapy/
brachytherapy
Salvage prostatectomy
Novel local salvage therapy
Ongoing Support
Local patient support network
Role of nurse/GP/healthcare professional team
Rising PSA levels
• The PSA concentration at which to define treatment failure after prostatectomy varies
in the literature.
Definitions of recurrence
• The Phoenix definition of relapse after radiotherapy is nadir plus 2. 97
• Patients whose PSA never falls to an undetectable level in the post-operative period are generally
considered to have systemic disease. However, some may have local disease amenable to salvage
radiotherapy, and so need to be assessed to determine the best management plan.
• A PSA concentration that rises rapidly in the post-operative setting may be indicative of metastatic
disease, while a PSA that remains undetectable over a long period then gradually rises may be
more likely to indicate local recurrence.
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