Theres More To Know About Rising Psa After Treatment
The goal is to help you focus on what you need to know about rising PSA levels so you can hold meaningful, regular dialogues with all members of your health care team as you find the treatment path thats right for you. Here are some questions you may have about the complexities of treatment in these casesand some answers that will help prepare you for the ongoing discussions and decisions to be made to keep your prostate cancer under control.
How Prostate Cancer Staging And Risk Stratification Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:
Localized, meaning theres no indication that the cancer has spread beyond the prostate
Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue
Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
What Is Salvage Prostate Cryoablation
Salvage cryoablation of the prostate is a procedure recommended for prostate cancer that has returned in men who have been treated previously.
Salvage literally means save. The doctor is trying to save the patient from the cancer. The procedure uses cryoablation, or extreme cold, to freeze the prostate, so that the cancer cells within it will freeze and die. It is also called cryosurgery or cryotherapy.
The procedure is typically done on an outpatient basis and is minimally invasive.
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Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
What Can You Expect After A Cryoablation Of The Prostate
After the procedure, your doctor will insert a catheter, or a drainage tube, to help urine leave the body. This is because its usual for the prostate to be swollen for about seven days, making it hard for you to urinate. Your healthcare provider will remove the catheter at an office visit about seven days after the procedure. Then you will be able to urinate on your own.
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Some Cancers Are Rising
Although the death rate for cancer has been on a steady decline, the new report also highlights that new cases of breast, uterine and prostate cancer have been of concern and rising in the United States.
Incidence rates of breast cancer in women have been increasing by about 0.5% per year since the mid-2000s, according to the report.
Uterine corpus cancer incidence has gone up about 1% per year since the mid-2000s among women 50 and older and nearly 2% per year since at least the mid-1990s in younger women.
The prostate cancer incidence rate rose 3% per year from 2014 through 2019, after two decades of decline.
Knudsen called prostate cancer an outlier since its previous decline in incidence has reversed, appearing to be driven by diagnoses of advanced disease.
On Thursday, the American Cancer Society announced the launch of the Impact initiative, geared toward improving prostate cancer incidence and death rates by funding new research programs and expanding support for patients, among other efforts.
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
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Do I Need Additional Treatment After Prostate Surgery
After surgery, one of the most important questions to ask is whether you may benefit from additional therapy, such as adjuvant radiation . The decision to use radiation to lower your risk of recurrence and dying from prostate cancer after surgery is based on whether the cancer has spread to your seminal vesicles, whether there were positive margins, and whether the cancer spread beyond the prostate capsule. In addition, it is important to allow time to recover your urinary function before considering radiation therapy after surgery, as radiation to this region increases the risk of urinary strictures, leakage, and high urination frequency.Many, but not all men, often can safely avoid adjuvant radiation therapy, and closely monitor their PSA to determine if they will need early salvage radiation therapy .
What To Ask When Your Psa Is Rising After Initial Treatment
For the majority of men, prostate cancer is treatable and curable and does not come back after initial treatment. However, about 25%33% of men with prostate cancer will experience a recurrence of their cancer after surgery or radiation. Some of these men can still be cured with additional treatment, but some men develop a form of prostate cancer that, while not curable, remains TREATABLE for a very long time.
Below is a list of questions to ask when your PSA is rising after initial treatment.
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Modern Imaging Modalities In Prostate Cancer: Pet/ct
The benefit to performing local treatment such as RT is critically dependent upon imaging methods and its accuracy to assess disease at local, nodal, and metastatic level . Traditionally, computed tomography and bone scintigraphy have been used for both staging and follow-up of patients with prostate cancer, yet they often lead to understaging. Indeed, CT was shown to have a 32% sensitivity only in detecting nodal metastases in a meta-analysis led by Hövels et al. , with both sensitivity and specificity dropping precipitously at low PSA levels, when indication for SRT is usually undertaken. Bone scintigraphy remains the standard for the detection of bone lesions, but pooled results from a meta-analysis revealed a sensitivity and specificity of 59 and 75%, respectively .
18F-Fluciclovine PET/CT is also indicated at BCR, after primary treatment with curative intent . It has the ability to detect amino acid transport, which is upregulated in numerous types of cancer cells . Fluciclovine PET/CT was found to be both more sensitive and more specific than choline PET/CT , and thus received approval by the Food and Drug Administration in the recurrent setting. In the phase III FALCON trial, the detection rate of Fluciclovine was 56% at a median PSA level at restaging of 0.79 ng/ml .
Focal Therapy For Prostate Cancer
With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer. Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function
Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.
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Good Prostate Cancer Outcomes Possible Despite Salvage Radiation Failure
Salvage radiation therapy given after radical prostatectomy may improve outcomes in prostate cancer patients, even in those who fail the treatment, according to study findings presented at the 56th annual meeting of the American Society for Radiation Oncology in San Francisco.
The study, led by radiation oncologist D. Nathan Kim, MD, PhD, Claus Roehrborn MD, and Yair Lotan MD, of the University of Texas Southwestern Medical Center in Dallas, included 61 PCa patients treated with SRT following radical prostatectomy from 1992 to 2000. The objective was to characterize the outcomes of those who failed SRT.
The median post-SRT follow-up was 126 months, during which 26 patients died, 10 from PCa. Of the 61 patients, 34 had PSA failure after SRT. These patients had a median follow-up of 157.5 months, during which 68% received androgen deprivation therapy . The median time from biochemical recurrence to initiating ADT was 48 months. The median overall survival was 13.6 years.
Dr. Kims group divided the patients who failed into 2 groups: those who failed within 1 year of SRT and those who failed more than 1 year after SRT. Compared with patients who failed SRT more than a year after treatment, those who failed within 1 year of treatment were 10.6 times more likely to die from PCa, 5.7 times more likely to die from any cause, 7.7 times more likely to develop distance metastases, and 8.9 times more likely to develop castration-resistant cancer at 10 years.
Radiation + Adt Superior For Prostate Cancer Salvage Therapy
| The following article features coverage from the American Society of Clinical Oncology 2019 meeting. |
Salvageradiotherapy combined with short-term androgen deprivation therapy formen with biochemical recurrence of prostate cancer after radical prostatectomyis associated with significantly improved 10-year metastasis-free survival comparedwith salvage RT alone, according to follow-up data presented at the 2019American Society of Clinical Oncology annual meeting in Chicago.
Thedata provide an update of findings from the GETUG-AFU 16 phase 3 randomizedtrial in which Christian Carrie, MD, CentreLéon Bérard, Lyon, France, and colleagues randomly assigned 743men withbiochemical recurrence of prostate cancer following radical prostatectomy toreceive RT alone or RT plus short-term ADT with goserelin .After a median follow-up duration of 5.3 years, the 5-year progression-freesurvival rate was significantly higher among men who received RT plus ADT thanamong those who received RT alone , according to findings publishedin Lancet Oncology.
Inthe updated analysis, the median duration of follow-up was 112 months. Comparedwith RT alone, the combination treatment was associated with a significant 46%decreased risk of progression overall and a significant 53% and 44% decreasedrisk among low- and high-risk patients, respectively, Dr Carrie reported.
Theauthors concluded that RT plus ADT can be considered as a new standard ofsalvage treatment after radical prostatectomy.
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Early Salvage Radiation After Rp Improves Outcomes In Relapsed Prostate Cancer
| The following article features coverage from the ASCO Genitourinary Cancers Symposium 2022. Click here to read more of Cancer Therapy Advisors conference coverage. |
Initiating salvage radiation therapy early after biochemical recurrence of prostate cancer following radical prostatectomy may prolong the time to metastasis, investigators reported at the ASCO Genitourinary Cancers Symposium 2022.
Among 408 patients with prostate cancer who received salvage RT, 187 received early salvage RT at PSA levels of 0.2 to 0.5 ng/mL.
Early-salvage RT was significantly associated with 48% and 42% reduced risks for biochemical recurrence and metastasis, respectively, compared with expectant management, Emerson Lee, a medical student at The Johns Hopkins University School of Medicine in Baltimore, Maryland, reported on behalf of his team. Median radiation dose was 68.4 Gy and did not differ significantly between groups.
Nodal involvement was significantly associated with 2.2-fold worse metastasis-free survival, Lee reported. Seminal vesicle invasion was significantly associated with a 1.8-fold increased risk for biochemical failure. The time from prostatectomy to salvage RT did not affect these outcomes.
Of the cohort, 133 patients received neoadjuvant or concurrent androgen deprivation therapy .
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors disclosures.
Reference
Natural History Of A Second Biochemical Failure After Salvage Radiation Therapy For Prostate Cancer
- BJU International
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Radiation Therapy In Localized Disease:
For men that need treatment for localized prostate cancer, external radiation therapy and brachytherapy can be alternatives to surgery. Modern radiation therapy is as effective as surgery when used to cure prostate cancer.
At this stage of disease, radiation therapy is used to attempt to cure the disease. However, it is also sometimes used if surgery didnt completely remove the cancer, or it came back in the area of the prostate after surgery.
These treatment options may require multiple visits. As always, it is important to consider costs and potential side effects. Scroll down to learn more about the different types of external radiation therapy or brachytherapy.
Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
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What Is The Difference Between Salvage Cryoablation Of The Prostate And Other Treatment Options For Prostate Cancer
Salvage prostate cryoablation, when used on the whole gland, destroys all of the prostate tissue. Other treatments do the following:
- Radiation therapykills the individual cells. The more aggressive the cancer, the harder the cells are to kill with radiation.
- Radical prostatectomy, or surgery to remove the entire prostate and some of the surrounding tissue, is sometimes done after failed radiation therapy. It has a risk of significant complications, such as incontinence and erectile dysfunction.
- Hormonal therapy, to reduce the level of male hormones, is another option and may be recommended to reduce tumor size and slow the cancer growth. It will not cure the cancer and has significant side effects.
New Data On Prostate Cancer Salvage Radiation And Survival
Alexander M. Castellino, PhD
Patients experiencing biochemical failure defined as an increase in prostate-specific antigen level after prostatectomy for prostate cancer often receive salvage radiation therapy to control the disease and prevent metastases.
However, despite SRT, some patients still exhibit biochemical failure. Now, a long-term, single-center study, July 9 in the American Journal of Clinical Oncology, has demonstrated that outcomes for 61 men who experienced a biochemical recurrence after surgery, including a subset of 34 men who experienced failure twice , are robust.
The median overall survival was 13.6 years for the men in the study who had two biochemical recurrences and 14.7 years for the men who had just the one recurrence after surgery, report the authors, led by D. Nathan Kim, MD, PhD, from Texas Oncology in Waco.
Furthermore, the 10-year prostate-cancer-specific, metastasis-free, and castration-resistant-free survival rates were all in excess of 70% for the men who had two biochemical recurrences.
The new retrospective data might be of service to clinicians in discussions with anxious patients because there is a “paucity” of prospective data about this clinical scenario, the authors suggest.
The extensive follow-up period makes the study one of the longest in the literature. Median follow-up was 126 months after SRT and 112 months after SRT failure. Most studies have a median follow-up of less than 90 months after SRT.
Study Details
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