Treating Cancer Recurrence

Despite the fact that initial prostate cancer treatments have been shown to be very effective in curing or eliminating the cancer, patients must understand their options if there is a reoccurrence of the cancer.

More and Better Options to Battle Recurrence after Surgery

Patients may have more and better options to treat a recurrence of prostate cancer if they choose to initially treat their cancer with a prostatectomy (surgical removal of the cancerous prostate).

Easier to Detect a Cancer Recurrence

It is easier and simpler for your doctor to detect a cancer recurrence when surgery is chosen as a first line therapy over beam radiation or seed implants. This is because PSA tests can be more easily used to detect a recurrence that occurs after a radical prostatectomy vs. radiation therapy.2

How Surgery Changes after Radiation

Surgery performed after radiation treatment for prostate cancer is often referred to as a salvage prostatectomy. A salvage prostatectomy is a more difficult operation to perform than a prostatectomy performed before any radiation treatment. Radiation will likely cause damage to surrounding tissues making careful dissection and visualization of important tissue planes and structures difficult. It may also be difficult to impossible to perform nerve sparing radical prostatectomies after radiation treatment (this will offer significantly worse outcomes for sexual function and continence than would otherwise occur if a nerve sparing procedure could be performed).1 Talk to your doctor about how prostate cancer surgery and outcomes may be different after radiation therapy.

Preserving the Radiation Option to Treat Recurrent Cancer

Patients may not be able to undergo additional radiation treatments after initial radiation treatment fails. However, patients that suffer a cancer recurrence after surgery may still receive radiation therapy. Talk to your doctor about how radiation therapy can be used after a prostate cancer recurrence if radiation therapy was not used as a first line treatment.

  1. Salvage Prostatectomy. Salvage prostatectomy is sometimes performed after unsuccessful radiation treatment if the cancer is still local. The odds of the procedure's success are only 10 - 64%. Many experts recommend against salvage prostatectomy in most cases of radiation failure. Severe complication rates for salvage prostatectomy are very high: 10 times that of men who have not had radiation. For example, incontinence after salvage prostatectomy is often untreatable with medications, collagen implants, or other standard treatment measures. (http://health.nytimes.com/health/guides/disease/prostate-cancer/options-if-treatments-fail.html)
  2. Di Blasio, C. J., A. C. Rhee, et al. (2003). Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol 30(5): 567-86.

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