Editing Biochemical Recurrence (section)

===== ADT =====
* '''Most commonly used treatment for biochemical recurrence after RT'''
* '''Generally not curative in these patients'''
** '''Patients with biopsy-proven local disease, no evidence of distant metastatic disease, and substantial life expectancy should be counseled about salvage local therapy''' such as prostatectomy, radiation approaches, and cryotherapy.
* '''The exact timing of ADT after failure is unknown.'''
** '''The ideal management of PSA recurrence in patients at high risk for failure may be the initiation of intermittent ADT.'''
*** In a recent clinical trial, intermittent ADT was found to be noninferior compared to continuous therapy in patients with PSA levels greater than 3 ng/mL without evidence of metastatic disease. This came with the benefit of potential improvement in physical function, fatigue, urinary problems, hot flashes, libido, and erectile function (Crook et al, 2012).
*** See Hormonal Therapy Chapter Notes
* Considering the potential morbidity and cost of ADT, it is reasonable to start treatment in those patients at highest risk for distant failure
** '''PSA doubling times < 12 months is associated with benefit from ADT after biochemical recurrence following radiation therapy to the prostate.'''