Consensus statements on radiation therapy of prostate cancer: Guidelines for prostate re-biopsy after radiation and for radiation therapy with risingprostate-specific antigen levels after radical prostatectomy

Purpose: To develop evidence-based guidelines for (1) prostate re-biopsy af ter radiation and (2) radiation therapy with rising prostate-specific antig en (PSA) levels after radical prostatectomy in the management of patients w ith localized prostatic cancer. Design: The American Society of Therapeutic Radiology and Oncology (ASTRO) challenged a multidisciplinary consensus panel to address consensus on spec ific issues in each of the two topics. Four well-analyzed patient data sets were presented for review and questioning by the panel. The panel sought c riteria that would be valid for patients in standard clinical practice as w ell as for patients enrolled in clinical trials. Subsequent to an executive session that followed these presentations, the panel presented its consens us guidelines. Results and Conclusions: Based on the data presented, the prostate re-biops y negative rates ranged from 62% to 80% for patients with stage T1-2 tumors . The panel judged that prostate re-biopsy is not necessary as standard fol low-up care and that the absence of a rising PSA level after radiation ther apy is the most rigorous end paint of total tumor eradication. Further, the panel judged that re-biopsy may be an important research tool. Based on th e data presented, the longterm (5 years or more) PSA remission rate after s alvage radiation therapy ranges from 27% to 45%. The panel requested result s from prospective randomized trials to evaluate optimally this information . The panel judged that the total dose of radiation should be 64 Gy or slig htly higher and that, in patients with or without radiation therapy, there is no standard role for androgen suppressant therapy for rising PSA values after prostatectomy. (C) 1999 by American Society of Clinical Oncology.