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Treatment of recurrent prostate cancer
The following are treatment options for recurrent prostate cancer. The types of treatments given are based on the unique needs of the person with cancer.
Hormonal therapy is the primary treatment for recurrent prostate cancer. Up to 85% of men with recurrent prostate cancer will respond to hormonal therapy. It may be offered to men who previously had surgery or radiation therapy.
The types of hormonal therapy are:
- luteinizing hormone-releasing hormone (LHRH) agonists
- leuprolide (Lupron, Lupron Depot, Eligard)
- goserelin (Zoladex)
- buserelin (Suprefact)
- LHRH antagonist
- degarelix (Firmagon)
- flutamide (Euflex)
- bicalutamide (Casodex)
- nilutamide (Anandron)
- abiraterone acetate (Zytiga)
- enzalutamide (Xtandi)
- surgical removal of the testicles (orchiectomy)
Radiation therapy may be offered for recurrent prostate cancer. The types of radiation is external beam radiation therapy:
- Men who previously had surgery but no radiation can receive radiation therapy in the area of the prostate. This can cure the cancer in some men.
- Men who had radiation therapy as their first treatment will not be able to have radiation to the area of the prostate. The normal tissues (bladder, rectum) will not be able to tolerate more radiation.
- It may be offered to treat bone metastasesmetastases1. A tumour formed by cancer cells that have spread from the original (primary) site to another part of the body. 2. The spread of cancer cells from the original (primary) site to other parts of the body. Metastasis can occur by direct growth or extension of a tumour into surrounding tissues in men who have had previous surgery or radiation therapy to the prostate.
Salvage radical prostatectomy – This may be used after radiation, HIFU (High intensity focussed ultrasound) or cryosurgerycryosurgeryA procedure that uses extreme cold (liquid nitrogen or liquid carbon dioxide) to freeze and destroy abnormal tissue. to treat a local prostate recurrence without metastasis. Incontinence and erectile dysfunction are common complications of salvage radical prostatectomy.
Cryoablation – This is an accepted treatment for recurrent prostate cancer after radiation therapy. The side effects are less than those for surgery, although it is unclear if cryoablation is as effective as surgery. Cryoablation can be repeated if necessary.
Transurethral resection of the prostate – TURP may be offered for castrate-resistant or hormone-refractory prostate cancer. This surgery is used to relieve symptoms of urinary obstruction caused by the prostate tumour (palliative surgery).
Biological therapy may be offered for recurrent prostate cancer. The type of biological therapy that may be given to men with recurrent prostate cancer is denosumab (Xgeva).
- Denosumab may be used to help prevent bone fractures in men with cancer that has spread to the bones.
- It may also help prevent spread of cancer to the bones in men who have rising PSA levels but no signs that cancer has spread to the bones.
Bisphosphonates can be used for prostate cancer that has spread to the bone to relieve bone pain or prevent fractures in men with advanced castrate-resistant prostate cancer. The bisphosphonate used is zoledronic acid (Zometa).
Men with prostate cancer may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.