Prostate cancer

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Treatments for recurrent prostate cancer

Recurrent prostate cancer means that the cancer has come back after it has been treated. When the only sign that the cancer has come back is that the prostate-specific antigen (PSA) level is going up, it is called a biochemical recurrence or biochemical failure.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The type of treatment that you receive will depend on:

  • the treatments you’ve already had
  • where the cancer comes back
  • whether or not you have other illnesses
  • your preferences

The following are treatment options for recurrent prostate cancer.

Radiation therapy

Radiation therapy may be offered for recurrent prostate cancer.

External beam radiation therapy

External beam radiation therapy is the type of radiation therapy that is most commonly used. It may be given together with hormonal therapy.

If the cancer was treated with surgery and it comes back in the same area of the prostate, radiation therapy may be used to treat it. If the cancer was treated with external beam radiation therapy, this treatment can’t be given to the same area again. This is because the radiation would do too much damage to the tissues around the prostate, such as the bladder and rectum.

External beam radiation therapy may be offered to treat prostate cancer that has spread to the bones (called bone metastases). This can be used in men who have had previous surgery or radiation therapy to the tumour in the prostate.

Brachytherapy

Brachytherapy is a form of radiation therapy that uses a radioactive substance (radioactive isotope) placed directly into the tumour or very close to it (called an implant). Some men may be offered brachytherapy to treat a recurrence if external beam radiation therapy was first used to treat the tumour in the prostate and if the cancer hasn’t spread to other parts of the body.

Systemic radiation therapy

Radium-223 (Xofigo) is a type of systemic radiation drug that is injected into the bloodstream. The radiation travels through the blood to where the cancer has spread. It gives off radiation, which kills the cancer cells. Radium-223 may be offered to men who have castrate-resistant prostate cancer that has spread to the bones. Castrate-resistant prostate cancer means that it comes back or doesn’t go away after treatment with hormonal therapy.

Hormonal therapy

Hormonal therapy is the main treatment for prostate cancer that recurs outside of the prostate area. Most recurrent prostate cancers will respond to hormonal therapy.

The types of hormonal therapy used to treat recurrent prostate cancer are:

Cancer that comes back after being treated with hormonal therapy is called castrate-resistant or hormone-refractory prostate cancer. Castrate-resistant prostate cancer is most often treated with another type of hormonal therapy.

Find out more about hormonal therapy.

Surgery

Surgery is sometimes used to treat recurrent prostate cancer.

Radical prostatectomy removes the prostate and some tissues around it. It may be used to treat cancer that recurs in the prostate. When a radical prostatectomy is used to treat recurrent cancer, it is often called salvage surgery.

Cryosurgery

Cryosurgery is a surgical procedure that uses extremely cold or freezing temperatures to destroy abnormal cells or tissue. Cryosurgery is sometimes used to treat cancer that recurs in the prostate when radiation therapy was the first treatment given.

Transurethral resection of the prostate (TURP) removes part of the prostate through the urethra. This surgery is done to reduce the size of the prostate. It is used to relieve urinary problems caused by an enlarged prostate pressing on the urethra.

Chemotherapy

Chemotherapy may be offered for recurrent prostate cancer that has spread to distant areas of the body (called metastatic prostate cancer) with or without hormonal therapy. Chemotherapy may be used when:

  • the cancer comes back or doesn’t go away after treatment with hormonal therapy (called castrate-resistant prostate cancer)
  • an adenocarcinoma changes into a more aggressive type of cancer

The chemotherapy drugs most commonly used to treat castrate-resistant prostate cancer are:

  • docetaxel (Taxotere) with prednisone
  • docetaxel, cabazitaxel (Jevtana) or mitoxantrone

Sometimes an adenocarcinoma of the prostate can change into a more aggressive type of cancer called small cell carcinoma of the prostate. These men often have prostate cancer that has spread to distant areas of the body (called metastatic prostate cancer) and low PSA levels. These men are treated with either:

  • cisplatin (Platinol AQ) and etoposide (Vepesid)
  • carboplatin (Paraplatin) and etoposide

High-intensity focused ultrasound (HIFU)

HIFU uses focused ultrasound waves to create intense heat, which destroys cancer cells. Right now, HIFU is an experimental treatment for prostate cancer. Sometimes doctors use it to treat prostate cancer that comes back after it is treated with radiation therapy.

Treatments for bone metastases

When prostate cancer spreads to other parts of the body, it most often spreads to bones. The most common treatments for prostate cancer that has spread to the bones are:

  • bisphosphonates
  • denosumab (Xgeva), which is a type of monoclonal antibody therapy
  • external beam radiation therapy
  • systemic radiation therapy with radium-223  

Find out more about bone metastases, including treatments and supportive therapies.

Corticosteroids

Corticosteroids are steroid hormones that act as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances). Corticosteroids are sometimes given with chemotherapy to help chemotherapy work better and to lessen the side effects of chemotherapy. Corticosteroids may also be used alone if a person is too sick to have chemotherapy. They can help slow the growth of prostate cancer cells and relieve symptoms such as pain.

Prednisone and dexamethasone (Decadron, Dexasone) are the corticosteroids most often used to treat prostate cancer.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

Many clinical trials in Canada are open to men with prostate cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

luteinizing hormone–releasing hormone (LHRH)

A hormone that controls the production of sex hormones in males and females.

The hypothalamus produces luteinizing hormone–releasing hormone (LHRH), which stimulates the pituitary gland to produce luteinizing hormone (LH). In turn, LH stimulates the testicles to produce testosterone and the ovaries to produce estrogen and progesterone.

Also called gonadotropin-releasing hormone.

adenocarcinoma

A cancerous (malignant) tumour that starts in glandular cells (cells that release substances such as mucus, hormones and lubricating fluids).

monoclonal antibody therapy

Treatment that uses monoclonal antibodies to detect and treat cancer.

Monoclonal antibodies are substances produced in the lab that can find and bind to a particular target molecule (antigen) on a cancer cell. They can be used alone, or they can be used to deliver drugs, toxins or radioactive material directly to a tumour.

Stories

Dr Shawn Li I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.

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