Not all cancer treatments are successful. Cancer may recur after initial and even after secondary treatment. Recurrence after Initial Treatment A number of options are available for prostate cancer recurring after initial treatment (PSA rising). These treatments include surgery, radiation, cryotherapy and HIFU, and are depending on the initial treatment and other factors. The timing of the follow-up treatment is connected with the doubling velocity of the PSA, the PSA nadir (lowest PSA value after initial treatment) and the treatment option itself. Progression free prediction models after initial treatment are available: "Pre-Treatment Nomograms". Results of these models should always be discussed with an urologists or radiation oncologist. Recurrence After Secondary Treatment A failed secondary treatment is usually followed by Androgen Deprivation Therapy (ADT). Most commonly LHRH agonists such as Lupron, Eligard and Degarelix are used. Sometimes combinations of the medication (ADT2) with antiandrogens such as Casodex and (ADT3) 5-alpha-reductase inhibitors such as Proscar and Avodart are preferred. ADT may accelerate loss of bone density. Zometa and Prolia (Denosumab) are two drugs approved to assist in maintaining bone health; another Denosumab formulation, Xgeva, is used for patients with metastasized PCa. |
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Resources An excellent summary of dealing with advanced prostate cancer is found in the Advanced Prostate Cancer Resource Kit, provided by Us TOO International. The sequencing of advanced PCa therapies is discussed by Daniel Petrylak, MD.
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