You will here the term "Biochemical Failure" or Biochemical Recurrence" in studies and in discussions. Lets be clear that this is a definition made primarily for studies to measure when someone "fails" in terms of the study. It does not necessarily mean there is an active failure - but actually probably, in the long term, it will be actual failure. Depending on the it may or may not mean you should have immediate follow-up treatment.
One one item to understand is the fact that many doctors use many different definitions of failures. They seem to pick and choose the one that gives them the best results. Different types of treatment groups seem to want their own failure definition - surgeons, radiation, etc. These differing definitions are not directly comparable and therefore give different results. This leads to confusions to patients trying to make a treatment decision.
Before I refer you to a paper that is pretty well written and covers this area let me add my two cents worth.
In my opinion I believe that the definition of failure (Biochemical Failure) should be the same for all treatment modalities. We know that the lower the PSA goes following any treatment the less chance there is to fail. Long ago Johns Hopkins established a definition of failure following surgery of a PSA of anything 0.2 and over. Yet we know that we see failure beginning at a much lower PSA. The question always is when do you treat.
It is my belief that all treatments should be based on this 0.2 (or lower) for a direct comparison. Now we know in radiation (of any kind) that it takes longer for the PSA to get down to these numbers. It can be even 7 years, however almost always at 5 years those who are going to fail are over 0.2 and the PSA will increase. So let me say that by 5 years after being treated those patients with a PSA of less than 0.2 for any treatment modality will likely not fail in the future. Be known that some will fail later than the 5 years as we have seen by studies - but the percent is small. Since there are so many things involved in the PSA I would guess these failures are patients close to the PSA of 0.2 or something else has happened in the PSA.
I firmly believe that 0.2 is not low enough to define failure. It is OK for comparison but we have studies showing the lower the better. Therefore I would like to see them move the definition of Biochemical failure of any PSA of 0.1 or higher - at five years past treatment date. I believe the evidence would show there would be almost no failures when the PSA is below 0.1.
As you will see in the paper that I refer you to they explain the mail definitions - but there are others. I take real exception to the definition being used in the radiation field. I do not believe for one second this is a logical measurement - it is a measurement to give the best results for a Radiation Oncologist so the "dumb" public will not know any better and will believe the Rad Onc and directly compare.
The morale of this story is not to believe any study or any doctor or clinic that gives you their results using any definition of failure (Biochemical failure) using any PSA of 0.2 or greater as that definition.
Now for the paper:
Biochemical PSA Recurrence
Introduction
In an excellent 2008 review article in the February 2008 Canadian Family Physician Wilkinson, Brundage and Siemens write [link]:
An increasing PSA level after curative therapy is termed a biochemical recurrence (BCR). Approximately one-third to half of patients will experience BCR during the course of their follow-up, regardless of modality of treatment. [PMID: 10886105] [PMID: 16600730] The significance of a BCR is in itself unclear, as not all men who have experienced BCRs will go on to experience metastatic disease. [PMID: 12605977] In one study, fewer than one-third of patients with BCR after RP developed systemic recurrence.[PMID: 12605977] In those patients who progress, BCR usually predates metastatic disease progression by an average of 7 years and prostate-cancer specific mortality by 15 years.[PMID: 16921049] [Full Text] Therefore it is useful in allowing enough lead time to implement effective salvage therapeutic strategies in those patients whose recurrences are deemed to be local (See [Table 1]).
Go to the paper by clicking "here" note that there are direct clickable links on the paper itself.
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