Options Available for Patients with Prostate Cancer Recurrence

A host of options are available for patients who experience prostate cancer recurrence.

Prostate cancer recurrenceDr. David Albala describes the many treatments for prostate cancer recurrence at different stages of the disease. Radiation and surgical intervention can be used in patients with prostate cancer recurrence. Those patients with more advanced stages of prostate cancer recurrence can undergo hormonal therapy. Immunotherapy, sometimes with a drug called Provenge, is also now available for patients with prostate cancer recurrence.

There are many options available to patients with prostate recurrence after they have been treated with the primary modality whether it is surgical intervention or radiation.  For those patients that have received surgical intervention who to their physician and start to see the PSA results climbing, those patients are candidates for radiation therapy or hormonal therapy, which are both options for prostate cancer recurrence.

 

David Albala:  So, what options are available to you as a patient if prostate cancer returns after surgical intervention or radiation therapy.

Well, there are a lot of options available to patients after they have been treated with the primary modality whether it is surgical intervention or radiation.  For those patients that have received surgical intervention, in other words their prostate was removed and all of a sudden, they go back to their physician and they start to see the PSA climbing, those patients are candidates for radiation therapy or hormonal therapy.

For patients that have had radiation therapy, we can go back in and if the PSA starts to rise, we can go back in surgically and remove the prostate, that’s called a salvage prostatectomy.  A salvage prostatectomy is a good operation, the goal is to get the prostate gland, the disease gland out of the patient, but you do pay a risk with that.  When one looks at continence rates and potency rates, they are much higher than what we see with the primary modality of doing surgical intervention at the front of the patient as a primarily modality when the patient is first diagnosed.  So, radiation and surgical intervention can be used in patients who develop a recurrence.

As men get more advanced prostate cancer, those patients can undergo hormonal therapy and hormonal therapy essentially forced the brain into shutting down the production of testosterone.  We know that testosterone is what drives the prostate and if you can shut down the production of testosterone, what that will do is slow down the growth of the prostate cancer and hence allow patients to live a much longer life, and that is considered first line therapy.  Once, you have patients that have disease that has spread into the bones or into the soft tissues in the body, those patients have advanced prostate cancer, we treat them with hormonal therapy and a large percentage of those patients will actually eventually go on to develop castrate resistant prostate cancer.

Now, for many years, chemotherapy with docetaxel was the only opportunity available for patients that have this condition who developed castrate resistant prostate cancer.  Over the last few years, we have seen some very exciting developments take place, immunotherapy with a drug called Provenge is now available in which blood can be harvested, the cells can be essentially reconfigured and then the cells are put back into a patient’s body and those cells, much like what antibiotics do with infection, can attack prostate cancer cells or slow down the growth of prostate cancer.

There are two new drugs that have come out, abiraterone and used in conjunction with steroids can have a significant effect in reducing castrate resistant prostate cancer progression.  We also now have a drug enzalutamide which could be used in these patients who develop castrate resistant prostate cancer.  Enzalutamide right now is approved in patients that have received chemotherapy, docetaxel chemotherapy that have progression, but there are tests undergoing right now, clinical studies looking at this drug being given before patients require chemotherapy.  So, this whole area of advanced prostate cancer, chemotherapy with docetaxel was really the only option a number of years ago and now we have seen an explosion take place with immunotherapy with Provenge, with abiraterone, with enzalutamide, new drugs are being developed that will help treat these patients that have refractory or castrate resistant prostate cancer.

Dr. David Albala
Dr. David M. Albala is Chief of Urology at Crouse Hospital in Syracuse, New York and Medical Director for Associated Medical Professionals. He is considered a national and international authority in laparoscopic and robotic urological surgery and has been an active teacher in this area for over 20 years.


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