The treatment of prostate cancer: how is failure defined and how can it be minimized?

Treatment failure after attempted curative treatment for prostate cancer includes death due to cancer, or the appearance of metastases. A more useful definition of treatment failure is a rising prostate specific antigen (PSA) level, or the presence of circulating cancer cells detected by polymerase chain reaction: diagnosis of failure by these tests holds open the possibility of further treatment. Appropriate patient selection before radical therapy, based on pretreatment PSA levels, biopsy Gleason score, and clinical staging, helps to reduce treatment failure, and ensure that the patients receiving radical therapy and those most likely to benefit. Neoadjuvant hormonal therapy is another approach to reduce treatment failure.