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What Is The Treatment For Recurrent Prostate Cancer

What Happens If Prostate Cancer Comes Back

Recurrent Prostate Cancer Cases – 2021 Prostate Cancer Patient Conference

The prostate is a small gland about the size of a walnut that helps make seminal fluid. Its intertwined with your urinary tract system, resting below your bladder and surrounding the urethra. As you age, this gland continues to grow, sometimes resulting in benign prostatic hyperplasia. While this growth is normal, cancerous growth is not. Cancer occurs when the cells in your prostate gland begin to grow out of control.

While prostate cancer is common, especially among older men, its got a fairly positive outcome. When caught early and treated, most men survive and continue on with remission after five years. Unfortunately, for a small percentage of men, the cancer returns. To give you some clarity on this situation, heres what happens if prostate cancer comes back.

Treating Recurrent Prostate Cancer

Prostate cancer can come back, even after you’ve had treatment and your doctor declared you cancer-free. Prostate cancer that returns after treatment is called recurrent prostate cancer.

Prostate cancer returns for a couple of reasons:

A prostate cancer recurrence is often treatable. It may even be curable. The treatments you’ll get this time around will be different from the ones you had before.Finding out your cancer has returned can bring back some of the same emotions you felt after your initial diagnosis.Your doctor, nurse, or a counselor can help you manage these feelings as you get ready for the next phase of treatment.

There Are Three Ways That Cancer Spreads In The Body

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

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Do I Need Treatment Right Away

Not necessarily. If your PSA level hasn’t risen much and you’re not at high risk of the cancer spreading, “active surveillanceââ¬ï¿½ could be an option.

Active surveillance means your doctor will monitor your cancer with regular PSA tests. If it starts to grow or cause symptoms, then you’ll start on a treatment.

Prostate cancer often grows very slowly and never becomes life-threatening. Active surveillance lets you delay treatment and avoid side effects, sometimes for many years. Another reason to wait is if you’re still recovering from side effects of your first treatment.

Not everyone is comfortable with the idea of putting treatment on pause. It’s a personal decision that you should make only after carefully weighing the pros and cons with your doctor.

Radiation Therapy For Prostate Cancer

Is HIFU an Option if the Cancer Comes Back?

Radiation therapy is an effective treatment that kills prostate cancer cells by using high energy rays or particles. The radiation can be delivered in several ways, including brachytherapy and external beam radiation that projects the energy through the skin. Radiation therapy for prostate cancer is best delivered by experienced radiation oncologists who work in high volume centers of excellence.

Radiation therapy can:

  • Treat both early stage cancers of the prostate gland and more advanced cancers that may have spread beyond the prostate
  • Be used alone or with other treatments such as hormone deprivation
  • Treat recurrent prostate cancer following surgery
  • Treat men with limited spreading prostate cancer to reduce the tumors size and improve survival and quality of life
  • Slow cancer growth, reduce fracture risk
  • Be used as a palliative treatment to address pain from advanced cancer

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How Soon Can We Detect This

One of the main advantages of surgery over radiotherapy for prostate cancer is that following prostate removal, the PSA should be very low , which we can of course detect with blood tests. If metastasis occurs, because the metastatic cells originated in the prostate and therefore make PSA, the PSA level in the blood starts to rise. Once it has reached a given threshold additional or salvage treatment will be discussed.

A PSA level of more than 0.2 ng/ml defines biochemical recurrence. At this stage the cancer is still much too small to be seen on scanning. If it can be seen on a scan it is termed clinical recurrence, which generally does not occur until the PSA level is more than 0.5 ng/ml. Symptoms, such as bone pain, dont usually occur until the PSA is more than 20 ng/ml.

Continuous Versus Intermittent Adt

Once the decision to use ADT has been made, a second controversial decision for BCR prostate cancer patients is whether to use intermittent or continuous administration of androgen deprivation. Intermittent androgen deprivation is a cyclic process in which induction treatment continues until maximal PSA response. ADT is then temporarily withdrawn until serum PSA levels rise to a predetermined level, agreed upon by patient and physician , at which point ADT is reinitiated. IAD can allow testosterone levels to recover during each off-treatment cycle, lessening sexual dysfunction and loss of bone mass often associated with continuous androgen deprivation.29 The lower cost and improved quality of life, combined with noninferiority of IAD in overall survival, have led many patients to choose IAD for treatment of BCR prostate cancer.

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Good Prostate Cancer Care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

How Is A Recurrence Detected

Evaluation and Management of Recurrent Prostate Cancer Following Radiation Therapy

After local treatment for prostate cancer, patients usually undergo routine blood tests to measure the levels of specific biomarkers in their blood. One such biomarker is the prostate-specific antigen used for both diagnosis and prognosis.

PSA defined biochemical recurrence is the primary method for reporting the outcome of definitive prostate cancer treatments. PSA levels in the blood are an indicator of cancer activity that decreases after treatment but increases during local or distant recurrence.

When PSA levels suggest that prostate cancer has come back or continues to grow, imaging-based tests are performed to detect and localize any recurrent cancer. The following imaging techniques are commonly utilized for this task:

  • Bone scan identify the involvement of the bones, typical site of prostate cancer metastasis.
  • Computed tomography produces cross-sectional images of the body to detect cancer in any part of the body.
  • Positron emission tomography produces a metabolic map of the body to identify cancer activity in any part of the body.
  • Magnetic resonance imaging produce cross-sectional images of the organs in the body to identify invasion.

Additionally, a prostate biopsy can help characterize the recurrent tumor and make informed treatment decisions.

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How To Handle A Relapse After Treatment For Prostate Cancer

Am I going to die? This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen level has risen after he has already undergone treatment for prostate cancer . The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.

Thats usually of small comfort to the patient whose PSA has risen. Its emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, its as if theyre dealing with another diagnosis of cancer, except this time its much worse because there is less likelihood of getting cured. A mans confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.

Treatments For Recurrent Prostate Cancer In Los Angeles Ca

Prostate cancer can re-occur after any type of radiation, including brachytherapy , Proton beam therapy, CyberKnife, external radiation of any type, high dose radioactive implants, etc. Estimates now are that up to 80,000 men per year return to urologists offices as radiation failures.

So, its not just the radiation side effects that can be problematic for patients who have chosen radiation to treat their prostate cancer, its dealing with the challenges of treating recurrent cancer.

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Treatments For Recurrent Prostate Cancer

Recurrent prostate cancer is cancer that comes back after it has been treated. Recurrent prostate cancer is also diagnosed when the prostate-specific antigen level starts to rise quickly after initial treatment but there are no other signs of cancer. This is called a biochemical recurrence or PSA failure.

The following are treatment options for recurrent prostate cancer. 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 the cancer has spread
  • your overall health and whether you have other illnesses
  • your age and life expectancy
  • your personal preferences

Some Patients May Still Benefit From Treatment With Adt

Salvage Radical Prostatectomy for Recurrent Prostate Cancer Urology o

Newer hormonal medications that inhibit the synthesis of androgen and block androgen receptor signaling are FDA-approved for the treatment of advanced prostate cancer.2-5

Xtandi targets multiple steps in the androgen-receptorsignaling pathway, interfering with molecular pathways that help the prostate cancer grow. Whats more, the drug does not cause side effects commonly associated with chemotherapy, such as nausea and hair loss. Xtandi has been shown to improve survival, reduce the risk of cancer progression, and delay the need for additional chemotherapy in men with HRPC.3,5

Zytiga® is an oral targeted agent that blocks the production of androgens not only by the testes, but also by the adrenal glands and the tumor itself. Zytiga when administered with prednisone has been shown to improve quality of life and delay patient-reported pain progression in HRPC patients. Although this medication is generally well-tolerated, side effects may include fatigue, high blood pressure, and electrolyte or liver abnormalities and patients need to be monitored regularly.6

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Rodent Models Of Male Osteoporosis

Osteoporosis affects aging men and leads to an increased risk of bone fracture. The development of male osteoporosis is associated with several risk factors, including androgen deficiency. The rat orchidectomy model is the most commonly used animal model of androgen deficiency and male osteoporosis.

Pharmatest can help you in determining the efficacy of your new drug candidates for male osteoporosis with the rat ORX model. When necessary a preliminary 2-week study can be first performed for identifying the best out of several potential compounds and finding its optimal doses. Efficacy of the best compound can then be confirmed with more extensive and longer studies. Preclinical efficacy studies can also be performed with intact male rats, or intact male mice that require lower amount of test compound.

Pharmatest has specific standard study setups for testing compounds with anti-catabolic and anabolic bone effects. We also provide tailored study setups for testing biosimilars and functional foods that have less extensive regulatory requirements. A list of bone analyses that we offer in our animal models can be found in our list of bone analysis services.

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Treatment For Recurrent Prostate Cancer

When prostate cancer has been detected or has returned following initial treatment with surgery, radiation therapy and/or hormone therapy, it is said to be recurrent or relapsed. The following is a general overview of the treatment of recurrent prostate cancer. Recent advances in treatment have resulted in new treatment options that reduce symptoms and improve survival. Each person with prostate cancer is different, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.

Treatment of recurrent prostate cancer depends on what treatment a patient has previously received and the extent of the cancer. Some patients have only a rise in PSA level as evidence of recurrent cancer. Other patients will have evidence of metastatic recurrent cancer on x-rays or scans. Patients who have prostate cancer that continues to grow despite hormone therapy are referred to as having castration resistant prostate cancer .

Treating Advanced Prostate Cancer

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If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

  • hormone treatment

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

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Prostatectomy Followed By Radiation

Some men will benefit from surgery after radiation if the recurrence is localized to the prostate. This is a very technically challenging operation and requires significant expertise to perform safely. Our surgeons at UCLA have extensive experience performing these surgeries and most often performed with robotic assistance. This procedure is called salvage prostatectomy and is most frequently performed by Dr. Robert Reiter. We also have extensive experience in utilizing HIFU and cryotherapy in men that require salvage therapy after radiation but are not able to undergo surgery.

Preclinical Research Cro In Oncology

Pharmatest offers translational models to test the efficacy of your oncology drug candidates. Our comprehensive oncology services include in vitro assays, in vivo efficacy models, radiotherapy testing service and ex vivo imaging technologies.

Pharmatest is a CRO specialized in orthotopic and metastasis models, and as bone experts we have special expertise in bone metastasis models. The major advantage of these models is the proper tissue microenvironment that is known to affect tumor properties and drug resistance. This increases substantially the clinical relevance and predictivity over traditionally used subcutaneous models that lack the proper microenvironment.

The following table lists cancer cell lines that are available in Pharmatest for orthotopic and/or metastasis models.

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Side Effects Of Radiation Therapy

Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.

With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.

This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.

Immediate Versus Deferred Adt

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When BCR patients experience clinical/radiographic metastatic disease, immediate initiation of ADT reduces further metastatic progression, improves pain , and reduces the development of skeletal-related events . Immediate ADT in the metastatic setting also reduces prostate cancerâspecific mortality, but does not necessarily improve overall survival because of increases in deaths from other causes.24,26 For nonmetastatic BCR patients, timing of ADT is controversial. Many men in the BCR setting choose to defer the initiation of hormonal therapy and prefer to allow their physician to monitor their PSA kinetics, bones scans, and CT scans on a regular basis. Two ongoing clinical trials are exploring the timing of ADT initiation after BCR following radiation, the Australian and New Zealand Timing of Androgen Deprivation trial and the Canadian Early vs. Late Androgen Ablation Therapy trial .

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