Adam S. Kibel, MD, presented “Managing Recurrence after Radical Prostatectomy” during the 44th Annual Ralph E. Hopkins Urology Seminar on February 6, 2025, in Jackson Hole, Wyoming.
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How to cite: Kibel, Adam S. “Managing Recurrence after Radical Prostatectomy.” February 6, 2025. Accessed Mar 2025. https://grandroundsinurology.com/managing-recurrence-after-radical-prostatectomy/
Managing Recurrence after Radical Prostatectomy – Summary
Adam S. Kibel, MD, explores the management of prostate cancer recurrence following radical prostatectomy, focusing on risk stratification, imaging advancements, and evolving treatment strategies. In this 21-minute presentation, Dr. Kibel presents a case of a 62-year-old patient with Gleason 9 disease, emphasizing the importance of PSA kinetics in determining prognosis and treatment direction.
Historical data suggests that while some patients can be safely monitored, those with rapid PSA doubling times and early recurrence require intervention. Advances in PSMA PET imaging have transformed decision-making, identifying local versus metastatic recurrence and guiding treatment planning. Dr. Kibel highlights the critical role of salvage radiation therapy, emphasizing early intervention.
Meta-analyses confirm that salvage and adjuvant radiation yield comparable survival benefits. The integration of androgen deprivation therapy with radiation therapy is well-established, particularly for patients with a high risk of micrometastatic disease. Recent trials investigating intensified androgen receptor inhibition with agents like enzalutamide, apalutamide, and abiraterone show promising results, potentially reshaping future management strategies. The EMBARK and PRESTO trials further validate the role of intensified systemic therapy, demonstrating prolonged metastasis-free survival.
Dr. Kibel underscores the need for tailored treatment, balancing oncologic control with quality-of-life considerations. While aggressive treatment benefits high-risk patients, those with indolent recurrence may avoid unnecessary therapy. The evolving landscape of systemic and targeted therapies continues to refine decision-making, optimizing outcomes for men with recurrent prostate cancer.
About The 44th Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 44th iteration of the meeting took place from February 5th to February 8th, 2025, in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Adam S. Kibel, MD, is the DiNovi Family Distinguished Chair of Urology at Brigham and Women’s Hospital and Dana-Farber Brigham and Women’s Cancer Center in Boston, Massachusetts. Dr. Kibel is also the Elliott Carr Cutler Professor of Surgery at Harvard Medical School, and Chairman of the Harvard Urology Residency Program. His clinical interests include genetics of prostate cancer, minimally-invasive surgical treatments for urologic cancers, and robotic surgery for urologic cancers.
Dr. Kibel received his undergraduate and medical degrees from Cornell University Medical School. Dr. Kibel completed his urology residency at the Harvard Urology Program and his fellowship at the Brady Urologic Institute at John Hopkins.
Dr. Kibel has been listed as one of America’s Top Doctors by Castle Connolly and was named a top urologist by Boston magazine for his work on minimally invasive treatments for urologic cancers. Dr. Kibel has authored over 250 peer-reviewed publications on his research, with topics including the identification of molecular markers of urologic tumors, adjuvant and neoadjuvant approaches to treatment of aggressive disease and improved imaging of patients with urologic malignancies. Dr. Kibel’s research has been supported by the National Cancer Institute, American Cancer Society, American College of Surgeons, and the American Foundation for Urologic Disease.
