What To Do When Radiation And Hormone Therapy Fail
For some men, radiation and hormone therapy do not put the brakes on prostate cancer that recurs after prostatectomy, and the disease continues to spread. In such cases, one treatment option may include chemotherapy with docetaxel , which may extend survival and effectively treat cancer pain. Another option is the immunotherapy; sipuleucel-T , which for now is limited to men with metastatic prostate cancer who have no symptoms or whose cancer pain does not require use of narcotics and who have not responded to hormone therapy.
Two other choices for men who have not responded to traditional hormone therapy are abiraterone , a form of hormone therapy that has been approved by the Food and Drug Administration for advanced cancer that has resisted previous hormone therapy; and enzalutamide , which is approved for men whose prostate cancer has spread and not responded to both hormone therapy and chemotherapy .
For the majority of men who undergo prostatectomy for localized prostate cancer, the disease does not recur. However, for those men who do experience prostate cancer recurrence, there are treatment options, and patients should discuss the risks and benefits of all the alternatives with their healthcare providers and loved ones before making a decision.
New Treatments And Technology Breakthroughs
Both local and distant recurrences can be treated with a new technology known as CyberKnife.
It gives patients a safe and effective alternative to other therapies with little to no side effects.
Many patients who had undergone radiation treatments before cannot have another round due to increased risk of severe side effects.
CyberKnife is non-invasive, has fewer treatment sessions, and is more comfortable than traditional radiation.
Among the most important benefits of CyberKnife, there is little risk of causing:
- Lowered sex drive
In addition, CyberKnife is able to treat hard to reach or inoperable distant tumors.
If your prostate cancer comes back, you now have a new treatment that is not only effective but safer and has less side effects.
Contact Central Wyoming Urological Associates at if you would like more information about CyberKnife for prostate cancer recurrence.
Diagnosing Back Pain And Prostate Cancer
A doctors first step in finding out the cause of back pain typically is to take an image, usually an X-ray or CT scan.
For men who have early stage or localized prostate cancer, that it would spread to the bone is very unusual, says Chris Filson, a doctor at the Atlanta Veterans Administration Medical Center. However, if a patient has more advanced prostate cancer, we have to do additional tests to ensure theres no involvement of the cancer in the bone.
A doctor who suspects or already has diagnosed prostate cancer will look for characteristic changes in the bone. The X-ray or CT scan also can indicate how much of your spine is affected and where.
In addition, an MRI can detect problems that an X-ray or CT scan cant.
Chiropractors are often the ones who first spot or suggest the presence of prostate cancer. Joint pain, especially back pain, often sends people to chiropractic care when they dont have any other symptoms of prostate cancer.
Whether youre seeing a chiropractor or medical doctor, be sure to provide your complete medical history. This can help your doctor diagnose your back pain. Its especially important to mention any personal or family history of cancer.
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Back Pain Can Actually Be Caused By Prostate Cancer And By The Time This Happens The Cancer Has Spread It Is At An Advanced Stage
In general, prostate cancer causes no symptoms, begins Kenneth Peters, MD, chief of urology for Beaumont Hospital, Royal Oak, MI.
Dr. Peters continues, In advanced cases, the cancer can metastasize to the bones, leading to back pain. Urinary retention or incomplete emptying of the bladder due to an enlarged prostate can at times be perceived as low back pain.
Low back pain has many possible causes, and there are different kinds of LBP, in that it can present in different ways.
Sometimes its accompanied by tingling or numbness radiating down a leg.
Sometimes LBP occurs only when you are in certain body positions, such as bending over, or standing up after sitting for long periods.
And there are people for whom LBP occurs only in the morning after getting out of bed, then dissipates soon after.
Sometimes low back pain is nearly constant but dull in nature.
The persistence is something to be concerned about, even if the level of pain is dull.
If youve been experiencing low back pain and it doesnt seem to be related to certain body positions and/or has not gone away after a week or two, do not blow this off.
Rather, bring this to the attention of your doctor and ask that your prostate be examined and that cancer be ruled out.
Dr. Peters, in practice for 30+ years, is board certified by the American Board of Urology. One of his specialties is treating bladder pain.
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Treatment Options After Recurrence
After surgery to remove your prostate
PSA levels are usually extremely low about a month after surgery. You may hear your doctor saying that your PSA level is undetectable . If your PSA level starts to rise,;this might mean the cancer has come back.
Your doctor might recommend:
- hormone treatment
After external beam radiotherapy
PSA levels usually get lower slowly over months or years. Defining the limit for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence, or;3 increases in a row .
Your treatment options may be:
- surgery to remove your prostate
- hormone treatment
- high;frequency ultrasound
After internal beam radiotherapy
PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence.
After hormone treatment
If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static.;If it rises this may suggest the cancer is becoming resistant to the hormone treatment.
If hormone treatment is no longer controlling your cancer, your doctor may suggest:
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How Is Recurrence Different From A Second Cancer
Being diagnosed with a second cancer is different from a recurrence because the second cancer begins in a different set of cells in your body and is not a metastasis of the original cancer. This would mean you have or had two separate cancers rather than one type that metastasized to another area of the body.
What Recent Research Tells Us About Prostate Cancer Screening
Depending on how often screening is done, it may help reduce the chances of dying of prostate cancer, but the research indicates that the vast majority of men with prostate cancer die of a different cause, even if they are not treated.
Two major research studies have tried to shed light on the value of regular screening: the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and the European Randomized Trial of Screening for Prostate Cancer .8 The PLCO studied 76,000 men, aged 55-74, for 7-10 years and found that the death rate from prostate cancer was low, and that it did not differ between the men who were screened every year for the first six years of the study and those who received their usual care .9 For most of the patients, usual care included at least one screening during the first seven years of the study. There were also no significant differences in overall death rates between the groups. Although the randomized portion of the study was completed in 2006, researchers are still studying the patients to see how long they live.10
Recent updates to a 2010 meta-analysis of six randomized, controlled prostate cancer screening trials further support the U.S. Preventive Services Task Force recommendations. Analysis of data on almost 330,000 men showed no significant difference in the risk of death from prostate cancer between the men who received PSA screenings and those who did not.13
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How Your Doctor Monitors You After Treatment
After treatment you have follow up appointments, which usually include regular blood tests to check the levels of a protein called prostate specific antigen . They check to see if your PSA level rises. And they also look at how quickly it rises.
An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in or around the prostate. Or they might have spread to other parts of your body. You might need treatment if it rises.
Prostate cancer that comes back after treatment is called recurrent prostate cancer.;
Table : Predictors Of Biochemical Recurrence At Time Of Diagnosis
Although a number of clinical factors contribute to your risk of relapse after treatment, the parameters below provide a simpler assessment of your chances of biochemical recurrence, based on your clinical profile at the time of diagnosis. For more sophisticated estimates, based on specific risk factors, see Figures 1 through 3.
Low risk Gleason score less than or equal to 6and Cancer stage T2c or more
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What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life,;making healthy choices and feeling as good as you can.
What Is An Elevated Psa Level
After your initial prostate cancer treatment, you likely had regular checkups with your doctor. These checkups usually include a blood test to monitor your prostate specific antigen .
If your blood test shows that your PSA has gone up after surgery, radiation, or hormone therapy, your doctor will likely order another PSA test to confirm the results.
If your PSA is still elevated after the test, recurrent prostate cancer is indicated. Imaging tests may then be scheduled to locate where the prostate cancer has returned in your body.
By learning about my recurrent prostate cancer and talking with my urologist, I can be my own best advocate.
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Second Cancers After Prostate Cancer
Prostate cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. Cancer that comes back after treatment is called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer.
Unfortunately, being treated for prostate cancer doesnt mean you cant get another cancer. Men who have had prostate cancer can still get the same types of cancers that other men get. In fact, they might be at higher risk for certain types of cancer.
Men who have had prostate cancer can get any type of second cancer, but they have an increased risk of certain cancers, including:
This risk is probably related to the dose of radiation. Newer methods of giving radiation therapy may have different effects on the risks of a second cancer. Because these methods are newer, the long-term effects have not been studied as well.
Four Key Mistakes To Avoid If You Are Diagnosed With Low
Here are key mistakes Dr. Hu has identified
- Mistake: Automatically opting for treatment when you have low-risk prostate cancer.;Even though treatment for low-risk prostate cancer is generally;not;recommended, in the recent study, more than 85% of the men with low-risk prostate cancer chose to have some sort of treatment. The most common treatment was radiation therapy , and the second most common was surgery . Just 15% opted to skip treatment. The good news is that, as the study went on, there was a trend toward a greater percentage of men opting for active surveillancea trend that has accelerated according to recent surveys. However, Dr. Hu thinks too many men are;still;missing out on this proven approach.
- Mistake: Choosing active surveillancebut not doing follow-up tests.;According to the results of this study,;fewer than 5%;of the men who skipped treatment complied with recommended monitoring. They had fewer office visits, and fewer repeat PSA tests, compared with men who had some form of active treatmentand only 13% underwent a second biopsy within two years, as recommended.
If abnormalities are detected on the digital rectal examination or PSA test, patients should undergo urologic evaluation with transrectal ultrasound-guided prostate biopsy. No further urologic evaluation is necessary in patients who have an unremarkable digital rectal examination and a normal serum PSA level, because the incidence of prostate cancer is only 0.4 percent in this group.15
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What Puts You At Increased Risk
Other factors that may increase your risk of developing prostate cancer include:
Age. Your risk of prostate cancer increases as you age. Its most common after age 50, with about six in 10 cases found in men older than age 65.
Race. African-American men are ata greater risk of prostate cancer than men of other races. As well, it affects African-American men at a younger age and is often more aggressive.
Family history. If you have a blood relative with prostate cancer, your risk increases. There are also other cancers that may be genetically related, and you may have an increased risk if you have a family history of breast or pancreatic cancer.
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Importance Of Knowing Why Cancers Recur
Often, cancer recurrence is metastatic. An initial cancer that was stage 1 or stage 2 can recur in stage 4 with metastases. More than 90% of cancer deaths occur due to metastases.
Cancer treatments are intended to prevent cancer cells from growing or persisting in the body. This is why adjuvant chemotherapy is part of the treatment for early-stage breast and lung cancers.
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Why Prostate Cancer May Return
Prostatectomy as a treatment option for prostate cancer is usually chosen by men who have localized prostate cancer; that is, it has not spread beyond the prostate gland. Therefore, the hope is that removal of the prostate will also rid the body of prostate cancer cells. A prostatectomy can be performed as either a traditional open surgery, a laparoscopic procedure, or as a robot-assisted approach . Most men who are candidates for traditional open prostatectomy can have a laparoscopic or robotic prostatectomy.
While recovery times and the risk of postoperative symptoms and complications differ depending on which type of prostatectomy you choose, the burning question after surgery is whether the cancer will come back. You may wonder how prostate cancer can recur if the diseased prostate has been removed.
Although a man may have prostate cancer that appears to be entirely localized , it is possible for some prostate cancer cells to migrate outside the prostate and beyond the surgical area, which includes not only the prostate but the tissue surrounding it that is removed during surgery.
For men who have a prostatectomy and whose prostate cancer is limited to the prostate and whose tissue surrounding their prostate and lymph nodes are free of migrating prostate cancer cells, survival is similar to that of a man who never had the disease at all. However, then there are men who have rogue cancer cells, and they face the possibility of needing to treat recurring prostate cancer.
How The Prostate Changes As You Age
Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren’t noticed until much later in life. An infection or a tumor can also make the prostate larger. Be sure to tell your doctor if you have any of the urinary symptoms listed below.
Tell your doctor if you have these urinary symptoms:
- Are passing urine more during the day
- Have an urgent need to pass urine
- Have less urine flow
- Feel burning when you pass urine
- Need to get up many times during the night to pass urine
Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation , enlarged prostate , and prostate cancer.
One change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.