Treatment options for prostate cancer recurrence

This review investigated treatment options following biochemical recurrence after primary treatment for prostate cancer.

Prostate cancer can be treated using a variety of methods, the most common being partial or full removal of the prostate gland, a procedure known as a prostatectomy. Other treatments include external beam radiation therapy, brachytherapy (types of radiotherapy), cryotherapy (the controlled freezing of the prostate gland to destroy cancer cells) and androgen deprivation therapy (a type of hormonal therapy). Although a large number of men with localized (confined) prostate cancer obtain a cure, some men can experience a recurrence (return of the cancer). A recurrence is often diagnosed by a raise in prostate specific antigen or PSA (a protein produced by the prostate gland whose levels rise in prostate cancer) levels in the blood. When after a treatment of prostate cancer a rise in PSA levels is discovered, this is known as a biochemical recurrence. The best treatment options for cancer recurrence (salvage treatments) are still not certain.

This review article looks at the results of 32 separate clinical trial regarding treatment options following prostate cancer recurrence. Results show that when patients were initially treated with a prostatectomy, after recurrence the most common salvage treatment was radiation therapy. In one study that included 635 patients with recurrent prostate cancer, of which 238 were treated with radiation therapy, with or without androgen deprivation therapy, showed that this treatment was associated with a 3-fold increase in survival compared to surveillance only. In patients initially treated with radiation therapy, a recurrence is commonly treated by prostatectomy. A study showed that 48%, 83% and 92% of the participants had 5 years free from biochemical recurrence, metastasis (cancer spread to distant organs of the body) and 5 years survival from prostate cancer, respectively when treated primarily with radiation therapy followed by prostatectomy following a recurrence. Other treatment options after primary radiation therapy included cryotherapy or brachytherapy. 

In summary, this review showed that radiation therapy for prostate cancer recurrence after radical prostatectomy can provide a good level of cancer control, especially when given early. This analysis found little evidence to support specific treatment methods for a recurrence which provide survival benefits.

Talk to your doctor about the most appropriate treatment in your situation.