What happens if the first treatment strategy fails?

This study examined patterns in the use of salvage therapy when primary treatment has failed.

The most common type of primary therapy is surgery or radiation. Unfortunately, primary therapy does not guarantee that patients will remain cancer free. Prostate specific antigen (PSA) is a protein produced by the prostate, and ncreased levels of PSA after surgery may indicate that the cancer has returned (biochemical recurrence).

A number of salvage therapy (treatment of residual or recurring cancer) options exist for patients with biochemical recurrence: hormone therapy (medical or surgical), chemotherapy, radiation therapy, brachytherapy (implanted radiation source at the tumor site) or cryosurgery (freezing technique to kill cancer cells). No specific guidelines exist to help choose which salvage therapy is best. Therefore, improving patient and physician knowledge of treatments and their specific patterns of use is important. 

6,275 men who received primary treatment for prostate cancer were included in the study. The primary treatment failed for 839 (13.3%) of patients. Of these, 47% received systemic salvage therapy (hormone therapy or chemotherapy to the whole body), 17% received local salvage therapy (radiation, cryosurgery or brachytherapy to the area near the tumors) and 36% received no salvage therapy.

The primary treatment used, the grade of the cancer and the clinical stage of the cancer were predictive of the type of salvage therapy selected. Patients with more aggressive cancer (8-10 Gleason grade) had 3.89 times higher odds of receiving systemic salvage therapy than patients with less aggressive cancers (Gleason grade less than 6). Patients with a higher cancer stage (stage T3; the cancer extends just outside the prostate) had 4.13 times higher odds of receiving systemic salvage therapy than patients with lower cancer stage (stage T1; low numbers of cancer cells present only in the prostate).

The authors concluded that the primary treatment used and the grade of the cancer were predictive of the salvage therapy selected. They also concluded that the use of local salvage therapy increased over the last decade and that the use of systemic salvage therapy decreased in that time.