In the last issue, Dr. Qiu introduced the latest views from ASCO GU 2024 on biochemistry after prostate cancer surgery. In this issue, I will talk to you about the problem of biochemistry. Many of my patients will ask me after the biochemical **: Director Qiu, can I take medicine? Let's take a look at the latest research reports on ASCO GU this time.
1) What is the standard after biochemistry?
At present, the guidelines recommend salvage radiotherapy for patients after biochemistry**, and can be considered in combination with endocrine therapy for about half a year** on this basis. It can be seen that radiotherapy is the basis of biochemistry. The basis of the biochemical concept is that it is considered "no metastasis" based on the evaluation of traditional imaging tools, but with the gradual popularization of PSMA CT, we have found that the so-called "no metastasis" in the past may actually have metastasis on PSMA CT. Therefore, in recent years, the definition and ** of biochemistry have also been constantly challenged.
2) Can only endocrine be used after biochemistry**?
The Embark study is one that challenges current guidelines. The study enrolled patients with postoperative biochemistry** and needed to meet the following criteria to be considered "high-risk":1PSA doubling time< 9 months; 2.Postoperative PSA >1 ng ml; 3.Testosterone 150ng ml; 4.No metastases were found on conventional imaging (bone scan, CT, etc.). These patients were randomized to receive three **:Endocrine ** + EnzalutamidevsEndocrine alone**vsEnzalutamide alone
It was found that neither endocrine ** nor enzalutamide alone could delay metastasis compared with endocrine ** alone. It is also based on the results of the Embark study that in June 2023, the US FDA approved enzalutamide as a monotherapy or enzalutamide in combination with endocrine ** for patients with high-risk biochemicals**.
3) Not all patients can choose to use endocrine only**!
So let's go back to the question above: Is it okay to only take medicine if you are biochemical? Obviously, we can't be so arbitrary. The Embark study enrolled all high-risk patients with postoperative PSAs of 1 or higher. Such patients are few and far among the follow-up patients in my outpatient clinic. If possible, Dr. Khoo recommends ECT bone scan and PSMA PET CT double scan after biochemistry**. If both scans are negative and the patient does not have high-risk factors, then radiotherapy alone or radiotherapy combined with short-term endocrine** is sufficient, after all, long-term endocrine ** has its own *** For patients with high-risk factors, enzalutamide endocrine ** can be considered.
Highlights:
1.Biochemistry **post** is rich in choice, how to choose is best based on a comprehensive imaging examination evaluation (bone scan + PSMA PET CT);
2.If ECT does not identify metastases and the patient has additional risk factors (PSADT < 9 months or PSA >1 ng mL), enzalutamide endocrine may be considered;
3.For patients with no identified metastases and no high-risk factors, a combination of observation and salvage radiation therapy Short-course endocrine therapy may be considered.
Reference: Asco GU 2024