Management Strategies for Biochemical Recurrence of Prostate Cancer

Question 1

Topic: PSA Recurrence Definition

Clinical Vignette:
A 58-year-old male patient underwent prostatectomy for localized prostate cancer. His post-operative PSA level was 0.1 ng/mL. Two months later, his PSA was 0.22 ng/mL on repeat testing.

Which of the following PSA levels would meet the criteria for PSA recurrence, as defined by the AUA Guidelines Panel?

A) 0.15 ng/mL
B) 0.18 ng/mL
C) 0.21 ng/mL
D) 0.25 ng/mL

Answer 1

Correct Answer: C) 0.21 ng/mL

Explanation:
PSA recurrence is defined as a value greater than or equal to 0.2 ng/mL with a second confirmatory laboratory value (Cookson et al., 2007). In this case, the patient’s initial PSA of 0.22 ng/mL meets this criteria, indicating PSA recurrence.

Reference: Cookson et al., 2007 - AUA Guidelines Panel

Question 2

opic: PSA Monitoring Post-Prostatectomy

Clinical Vignette:
A 62-year-old male patient had a radical prostatectomy for prostate cancer. He has been regularly monitored post-surgery. His PSA levels have been consistently undetectable for the past 5 years.

What is the significance of undetectable PSA levels in the post-prostatectomy period?

A) Indication of disease progression
B) Suggestive of PSA recurrence
C) Expected outcome after surgery
D) Need for additional imaging

Answer 2

Correct Answer: C) Expected outcome after surgery

Explanation:
In the post-prostatectomy period, undetectable PSA levels are an expected outcome after successful surgery. They indicate the removal of the prostate gland and the absence of prostate tissue producing PSA. This is a positive outcome and signifies a successful surgical result.

Question 3

Topic: Imaging Modalities for Prostate Cancer Recurrence

Clinical Vignette:
A 65-year-old patient who underwent prostatectomy for prostate cancer presents with a rising PSA level of 0.18 ng/mL. His physician is considering imaging options to detect recurrence.

Which of the following statements about PET/CT and multiparametric magnetic resonance imaging (mpMRI) is accurate?

A) PET/CT is the preferred option for detecting local recurrence.
B) PET/CT is less expensive than mpMRI.
C) mpMRI has limited clinical utility at low PSA levels.
D) mpMRI outperforms PET/CT in identifying local recurrence, especially at low PSA levels.

Answer 3

Correct Answer: D) mpMRI outperforms PET/CT in identifying local recurrence, especially at low PSA levels.

Explanation:
Multiparametric magnetic resonance imaging (mpMRI) has been shown to perform better than PET/CT in identifying local recurrence, especially at low levels of biochemical failure. PET/CT has demonstrated promise in detection but is limited by cost and variable clinical utility at extremely low PSA levels.

Reference: Panebianco et al., 2012

Question 4

Topic: Limitations of Imaging Modalities

Clinical Vignette:
A 54-year-old patient with a history of prostate cancer recurrence is considering undergoing PET/CT for further evaluation. He is concerned about the potential limitations of this imaging modality.

Which of the following represents a limitation of using PET/CT for detecting prostate cancer recurrence?

A) PET/CT is cost-effective for all patients.
B) PET/CT is highly accurate even at extremely low PSA levels.
C) PET/CT is widely available and accessible.
D) PET/CT’s clinical utility is limited at extremely low PSA levels, leading to variable detection.

Answer 4

Correct Answer: D) PET/CT’s clinical utility is limited at extremely low PSA levels, leading to variable detection.

Explanation:
PET/CT has demonstrated promise in the detection of prostate cancer recurrence, but its clinical utility is limited at extremely low PSA levels. This limitation results in variable detection rates and contributes to its restricted widespread usage.

Question 5

Topic: Salvage Radiation Therapy for PSA Recurrence

Clinical Vignette:
A 58-year-old patient who underwent radical prostatectomy for prostate cancer is now experiencing PSA recurrence. He is considering treatment options for long-term freedom from progression.

What is the recommended treatment option for men with PSA recurrence after radical prostatectomy, and why is it considered the clearest choice?

A) Chemotherapy for improved cancer control
B) Hormone therapy to manage symptoms
C) Salvage radiation therapy for long-term freedom from progression
D) Radical prostatectomy with higher dosages

Answer 5

Correct Answer: C) Salvage radiation therapy for long-term freedom from progression

Explanation:
Salvage radiation therapy is the recommended choice for men with PSA recurrence after radical prostatectomy. It provides the best chance for long-term freedom from progression. Modern series using higher dosages of radiation therapy have shown improved cancer control results, making it a clear choice for treatment.

Question 6

Clinical Vignette:
A 63-year-old patient is scheduled to undergo salvage radiation therapy for PSA recurrence following radical prostatectomy. He is concerned about potential side effects and toxicities associated with radiation therapy.

What advantage do modern radiation delivery systems offer in terms of toxicity profile for patients undergoing salvage radiation therapy?

A) They reduce the need for hormone therapy.
B) They eliminate all potential side effects.
C) They improve cancer control results.
D) They provide an improved toxicity profile compared to older delivery systems.

Answer 6

Correct Answer: D) They provide an improved toxicity profile compared to older delivery systems.

Explanation:
Modern radiation delivery systems have an advantage in terms of toxicity profile. They offer an improved toxicity profile compared to older delivery systems, contributing to better patient outcomes and reducing potential side effects.