A 62-year-old man comes to the physician because of urinary frequency. His medical problems include hypertension that is well controlled with hydrochlorothiazide. His father had prostate cancer. A hard prostate nodule is palpated on rectal examination. Prostate biopsies reveal adenocarcinoma, and the patient undergoes radical prostatectomy. Postsurgery specimen shows cancer extension beyond the capsule, with clean surgical margins. Gleason score is 8 (4 + 4). Postsurgery prostate-specific antigen (PSA) level is undetectable. The patient comes to the physician for a follow-up examination 3 months later. He has no complaints. His PSA level is elevated at 9 ng/mL. He undergoes local external beam radiation therapy. The radiation therapy in this patient is most appropriately characterized as which of the following?

Question

A 62-year-old man comes to the physician because of urinary frequency.  His medical problems include hypertension that is well controlled with hydrochlorothiazide.  His father had prostate cancer.  A hard prostate nodule is palpated on rectal examination.  Prostate biopsies reveal adenocarcinoma, and the patient undergoes radical prostatectomy.  Postsurgery specimen shows cancer extension beyond the capsule, with clean surgical margins.  Gleason score is 8 (4 + 4).  Postsurgery prostate-specific antigen (PSA) level is undetectable.  The patient comes to the physician for a follow-up examination 3 months later.  He has no complaints.  His PSA level is elevated at 9 ng/mL.  He undergoes local external beam radiation therapy.  The radiation therapy in this patient is most appropriately characterized as which of the following?

Quizplus · Accepted Answer

This patient presents with a PSA recurrence of advanced prostate cancer. He initially had localized disease treated with radical prostatectomy, with good results and undetectable postoperative PSA. However, he now has a PSA recurrence without any symptoms. Because he failed the initial therapy for the prostate cancer, he undergoes local external beam radiation therapy to kill residual tumor cells. The radiation therapy is considered salvage therapy, defined as a form of treatment for a disease when a standard treatment fails. For men with PSA recurrence after radical prostatectomy, salvage radiation therapy can provide long-term disease control for localized recurrent disease. (Choice A) Adjuvant therapy is defined as treatment given in addition to standard therapy. This would be the case in this patient if the radiation therapy was given at the same time as the radical prostatectomy. (Choice B) Consolidation therapy is typically given after induction therapy with multidrug regimens to further reduce tumor burden. An example is multidrug therapy after induction therapy for acute leukemia. (Choice C) Induction therapy is an initial dose of treatment to rapidly kill tumor cells and send the patient into remission (<5% tumor burden). A typical example is induction chemotherapy for acute leukemia. (Choice D) Maintenance therapy is usually given after induction and consolidation therapies (or initial standard therapy) to kill any residual tumor cells and keep the patient in remission. An example is daily antiandrogen therapy for prostate cancer. (Choice E) Neoadjuvant therapy is defined as treatment given before the standard therapy for a particular disease. This would be the case in this patient if the radiation therapy was given before the radical prostatectomy was done. Educational objective: Salvage therapy is defined as treatment for a disease when standard therapy fails, such as radiation therapy for prostate-specific antigen recurrence after radical prostatectomy for prostate cancer. References: Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy (http://www.ncbi.nlm.nih.gov/pubmed/18560003)

A 62-Year-Old Man Comes to the Physician Because of Urinary