Editing Biochemical Recurrence (section)

=== Androgen Deprivation Therapy for Biochemical Failure after Radical Prostatectomy ===
* '''ADT is non-curative for biochemical failure after radical prostatectomy (unlike salvage radiation which an be curative)'''
** '''No data from prospective trials address a possible progression-free or overall survival benefit in the post prostatectomy setting'''
** Despite the lack of survival benefit, ≈60% of patients with biochemical failure after radical prostatectomy will undergo ADT as second-line treatment
* '''2020 AUA Advanced Prostate Cancer Guideliens: not recommended'''
** '''ADT should not be routinely initiated for biochemical recurrence after radical prostatectomy'''
*** Two large observational studies found no difference in mortality in patients treated with immediate vs. deferred ADT for biochemical recurrence.
*** It is recognized that ADT is sometimes given to men with rapid PSA rises in the absence of radiographic metastases in an attempt to delay the appearance of metastases. There is no evidence to determine the best time to start ADT in the absence of radiographic metastases.
*** '''If ADT is initiated in the absence of metastatic disease, intermittent ADT may be offered in lieu of continuous ADT.'''
* '''Monotherapy with high-dose bicalutamide (150mg daily) administration has been reported to delay disease progression and yield overall survival results equivalent to those of treatment with orchiectomy among patients with PSA recurrence.'''
** '''A possible advantage of this form of hormone therapy is that it is associated with less risk for sexual dysfunction and osteoporosis than other forms of ADT.'''
** '''A disadvantage is a possible increased risk for cardiovascular complications and death associated with high-dose bicalutamide therapy.'''
** Wirth, M., et al. "Bicalutamide (Casodex) 150 mg as immediate therapy in patients with localized or locally advanced prostate cancer significantly reduces the risk of disease progression." Urology 58.2 (2001): 146-150.