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.
Imaging techniques such as the Axumin Pet/CT scan may be able to identify the recurrence location, assisting in establishing treatment plans. This scan is widely available with more than 10 locations just in the DFW Metroplex.
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 Firmagon (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.
webinar video: ADT Management, Side Effects (Richard Wassersug, PHD)
YOUR treatment may be different
Failure of Hormone Management
Though hormone management may have been administered through your urologist, treatments for hormone refractory patients are usually administered by an oncologist.
Treatments after failure of ADT include
- Radiation
This is different from radiation for primary or secondary treatment; the radiation is directed at metastasized cancer lesions
- Chemotherapy
The most common drug for chemotherapy is Taxotere® (docetaxel). Other drugs are available.
- Immunotherapy is a new treatment option available for hormone refractory prostate cancer patients. This therapy is available for patients with no pain from bone-metastases; see paragraph below.
- Second line treatments, usually administered after chemotherapy, include ZytigaTM (abiraterone), Xtandi (MDV3100) and Jevtana® (cabazitaxel).
- FDA just approved the new injectable radioactive agent Xofigo® (radium-223 chloride, Alpharadin®).
- Clinical Trials
There are a number of ongoing clinical trials focused on hormone management failure. Check with your oncologist for trials available.
AUA/ASTRO Guidelines for Radiation After Prostatectomy
AUA Guidelines for Treatment of Advanced 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.
For the latest information on drug sequencing and novel approaches go to Optimizing Outcomes of Advanced Prostate Cancer ...
Also read Gaining on Prostate Cancer
Immunotherapy is a new treatment option available for hormone refractory prostate cancer patients . Provenge® is a process designed to fully activate a man's immune cells to better identify prostate cancer cells as abnormal cells in the body. A Provenge® provider list (enter your zipcode) is available.