Management of Biochemical Recurrence

Posted by Peter R. Carroll, MD, MPH | Aug 2021

Peter R. Carroll, MD, MPH, presented “Management of Biochemical Recurrence” during the 31st International Prostate Cancer Update in July 2021 in Snowbird, Utah.

How to cite: Carroll, Peter R. “Management of Biochemical Recurrence.” July 2021. Accessed Apr 2024. https://grandroundsinurology.com/prostate-cancer-early-detection-2021/

Management of Biochemical Recurrence – Summary

Peter R. Carroll, MD, MPH, Professor of Prostate Cancer and Urology at the University of California, San Francisco, discusses advancements in knowledge of biochemical recurrence post radical prostatectomy. He begins with an overview of the evolution of radical prostatectomy (RP), highlighting that it has become a treatment option designated for high-risk patients, more multimodal, and more enhanced by biomarker and imaging technology. Dr. Carroll shows data from the CAPTURE trial suggesting that when looking at 18-year cause-specific mortality, RP has a benefit to high risk patients over low risk patients. He reviews data from a Martini-Klinik trial on PSA after RP predicting cancer death that found 75.5% survival in RP patients with detectable PSA vs 96.2% in patients with undetectable PSA. Dr. Carroll also discusses data from a trial he took part in managing which supports the data from Martini-Klinik. He then overviews data from the RAVES, GETUG – AFU 17, and RADICALS RT trials that all compare salvage therapy against adjuvant and found no real difference in outcomes with differences of 3% at most. Dr. Carroll reviews data showing that early adjuvant therapy has a survival benefit for high-risk patients with Gleason scores of 8-10 and UCSF data showing 33% salvage PSA recurrence-free survival post salvage radiation at 10 years. He discusses how empirically based treatment strategies don’t take into account the treatment niches shown by the data he has reviewed and recommends that exact treatment strategies are utilized on a patient by patient basis and that a measured approach to managing biochemical recurrence is utilized.

About The 31st Annual International Prostate Cancer Update:

The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. Dr. Carroll delivered this educational activity during the 31st iteration of the meeting in July 2021 in Snowbird, Utah.

About The Author

Peter R. Carroll, MD, MPH

Dr. Peter Carroll holds the Ken and Donna Derr-Chevron Professorship in Prostate Cancer and the Taube Family Distinguished Professorship in Urology at the University of California, San Francisco (UCSF). He is also the Associate Director of Strategic Planning and Clinical Services and Program Leader of the Prostate Cancer Program at the Helen Diller Family Comprehensive Cancer Center at UCSF. Dr. Carroll graduated with honors from Georgetown University School of Medicine. He then went on to complete general surgery training and a urology residency at UCSF, as well as a Fellowship in Urologic Oncology at Memorial Sloan Kettering Cancer Center in New York City. He has taught at the UCSF Department of Urology since 1986, and he became the department chair in 1996. Under his leadership, the department has been consistently ranked one of the top urology departments in the country by U.S. News and World Report. The department has grown, serving an increasingly larger patient population, expanding its research programs, and attracting future leaders in the field for training. Under Dr. Carroll’s leadership, the department managed an average of over $10 million in research grants that put UCSF in first place for urology funding for five consecutive years. Dr. Carroll also established the UCSF Department of Urology’s Tissue Core, a biobank of blood, urine, and residual prostate, bladder, and renal tissues for more than 6,000 consenting patients. In addition to his many accomplishments at UCSF, Dr. Carroll has authored or co-authored over 650 publications, is an active member of numerous professional medical societies, and is currently principal or co-investigator on numerous scientific studies. He is also Past-President of the American Board of Urology (2006-2008). His drive to perfect nerve-sparing prostatectomy has led to many technical innovations, and his pioneering efforts in standardizing an active surveillance regimen has led to many patients postponing radical treatment while maintaining a low risk of cancer progression.

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