Reoccurance Of Prostate Cancer After Brachytherapy
| Jul 20, 2012 – 10:53 am
I am 53 years old and had brachytherapy in 2/2010. My PSA rose to 4.5 and had new biopsy completed a couple of weeks ago, which showed risidual cancer with a gleason of 6. I am now researching my options for treatment. I would be interested in hearing from others who have been in my situation and learning what treatment they recieved and how they are doing. I am considering the temporary brachtherapy procedure or prostatectomy. There is so much research on success/failure, potential side-effects, that it’s a bit overwhelming. |
Differences Among Risk Groups
Men with PCa have been classified into low-, intermediate- and high-risk Groups for tumor recurrence and disease specific mortality, based on PSA level, clinical or pathological staging and GS. High-risk patients have PSA level 20ng/mL or GS 8 or clinical/pathological stage T2c . Lymph-node positive and PSM have also been reported as poor prognosis factors.
Risk Group classification predicts biochemical and clinical progression as well as PCa specific mortality and overall survival. The risk of disease progression in these groups has been validated for patients submited to RP in many studies. In patients from Mayo Clinic, BCR rates were 2.3 and 3.3-fold greater in high and intermediate-risk in comparison with low-risk patients, respectively. In those patients, mortality rates in high and intermediate-risk patients were greater than 11 and 6-fold over low-risk men .
Therefore, it is crutial to understand the role of each clinical and pathologic feature in PCa BCR and disease progression.
About Prostate Cancer Recurrence
What’s the prostate cancer recurrence rate? Can I do anything to prevent it? What treatment options are offered for the recurrence of prostate cancer?
Follow the paragraphs below to get the answers.
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First of all, I want you to understand that the recurrence occurs after the entire treatment has been terminated. That means that tumor appears again in the same location or/and other locations .
At the same time, the recurrence rate depends on various factors. So, if a radiation therapy is used as a treament of choice, the chance of recurrent prostate cancer is highest. This area is considered the most high risk zone.
The following table will show the risk rates for different types of treatment.
Table
I want you also to realize that the risky zone comprises only 10% of the affected population. What is more, the majority may not face this scenario in their life time.
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After Surgery To Remove The Prostate
Following a prostatectomy, the course of treatment generally follows a similar path for all patients, with variations and adjustments made as needed based on test results, physical response, and overall progression of recovery, from both a provider and patient perspective. Almost universally among post-operative men who have had a cancerous prostate removed, levels of PSA are expected to drop, and this decrease is seen in a measurable way that follows suit.
However, prostate cancer is not limited to the borders of the gland itself, and it is commonly found to metastasize in the tissues directly surrounding the prostate, or in the nearby seminal vesicles . If cancer spreads after a prostatectomy, it is likely going to be found in one or both of these areas. It can also cause the affected individual to exhibit elevated levels of PSA, which, as youll recall, should be steadily dropping or fully depleted after surgery has been completed.
The Frequency Of Bcr Cp Crd And Rates Of Bpfs Cpfs Css
Median time of follow-up after RP was 64 months. Over this time, 207 men experienced BCR. One hundred twenty-seven men had BCR in the following year after RP, 27 in the second year, 16 in the third, 14 in the fourth, 7 in the fifth, and 16 patients had BCR after 5 years . Of 207 men, 181 received salvage radiotherapy or hormone therapy or both sRT + HT due to BCR.
Figure 1. Risk of biochemical recurrence by the following year after radical prostatectomy .
CP was diagnosed in 49 cases. Median time from BCR to CP was 17 months. Twelve men had metastases in lymph nodes, 11 had metastases in bones, 19 had metastases in lymph nodes and bones, 1 had visceral metastases, and 6 had local recurrence in the surgical bed. During the follow-up, 72 patients died. In 24 cases PCa was the cause of death.
According to the D’Amico risk classification, the 5-year BPFS rate after RP of patients with one risk factor was 57.7%, and that with two factors was 34.4%. All patients with three risk factors had BCR in the first 5 years after RP .
In all study cohorts, 5- and 10-year BPFS rate was 49.2 and 34.2%, respectively. CPFS rate was 89.2 and 81% and CSS rate was 95.6 and 90.1%, respectively.
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Even When Prostate Cancer Returns Most Survive
By Anne Harding, Reuters Health
5 Min Read
NEW YORK – Men who show signs that their disease has returned after prostate cancer treatment are still more likely to die of other causes, a new study in US veterans shows.
Nevertheless, researchers say the study underscores the need to find a better way to identify the minority of men who will die of prostate cancer after disease recurrence.
We often dont know what to tell these men in terms of their risk of dying of prostate cancer, Dr. Timothy Daskivich of the University of California, Los Angeles, told Reuters Health.
Detecting prostate cancer is most often done with a blood test that measures concentrations of prostate-specific antigen, or PSA, a protein made in the prostate that becomes elevated in men with prostate cancer.
After treating prostate cancer with surgery or radiation, PSA levels are monitored. If PSA levels begin to increase, this can serve as an early indicator of disease recurrence. But the effect of a rising PSA after treatment — also known as biochemical recurrence — on mens subsequent risk of dying from prostate cancer is not clear.
To investigate, Dr. Edward M. Uchio of the VA Connecticut Healthcare System in West Haven and Yale University School of Medicine in New Haven and his colleagues looked at 623 men who had been diagnosed with prostate cancer between 1991 and 1995 and were followed for up to 16 years after treatment.
During follow up, 420 men died, but only 86 died of prostate cancer.
How Liquid Radiation Works
Radiation treatment, also known as radiotherapy, is a powerful therapy used to kill cancer cells and shrink tumors. In the case of young Ben, the radiation was injected into his body and he became radioactive immediately. Radiation can be highly dangerous to those with a healthy immune system, so Ben was left alone for four days in a lead-lined room. His parents were only allowed to visit for a short time period and had to wear radiation gear prior to entering the room.
Unlike radiation beams that can only target one area, liquid radiation hits many spots at once where tumors may be hidden. This allows for direct access to the cancer. The body will dispose of the radiation as a by-product in urine. Precautions must be made at the hospital during treatment as to not expose patients or staff to the radiation.
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Caring For Your Incision
The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.
How Prostate Cancer Recurrence Is Detected
Following surgery for prostate cancer removal, the majority of patients will have regular appointments to check in and assess recovery progress with their healthcare provider or preferred oncologist. At each of these visits, your doctor will draw blood to run tests on various levels of biomarkers, hormones, and immunological markers, including PSA. You may also undergo minor physical assessments as part of your post-prostatectomy preventive maintenance care plan.
If prostate specific antigen levels are found to be rising, staying the same as pre-operative quantities, or slowing their rate of decrease in an unexpected way, your provider may suggest imaging tests or an X-ray of the prostate and pelvic area. A few other alternative options for detecting prostate cancer recurrence are available, although some are in the early stages of development or are not yet widely available, so should not be used as a default or go-to option for determining whether metastatic resurgence is a clear and present health risk.
Are you a practicing healthcare provider or oncologist who would like to learn more about alternative options for localized detection of recurrent prostate cancer?
Check out the full infographic here.
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Detecting Prostate Cancer Recurrence
If you have recurrent prostate cancer, its usually detected during follow up appointments. Once you undergo initial prostate cancer treatment, youll need to see your urologist once every few months to monitor your PSA levels and discuss any new symptoms. If your PSA levels begin to rise, it can be an indication that the cancer has returned. Your doctor will use imaging tests to try and locate the cancer and determine the best course of action for a second round of treatment. Tools for detection are continually improving, so be open to suggestions from your doctor.
What Factors Influence Cancer Predictions If The Psa Level Is Elevated
As previously noted, PSA rising after surgery can mean many different things in terms of the status of prostate cancer. These different prognoses are based on several different factors, outlined below:
- Gleason Score of Prostate Cancer: The Gleason score is a measure of how aggressive the cells of prostate cancer are. The higher the score, the more aggressive cancer. Men with higher Gleason scores who experience PSA recurrence are at greater risk for metastasis of prostate cancer than those men with lower Gleason scores. Is the Gleason Score 7 or less or is it 8 or higher?
- Time from Surgery: How soon after surgery the PSA reappears is one indicator specialists use to determine the aggressiveness of cancer. Generally, the longer the time between surgery and PSA recurrence, the less likely cancer is aggressive and going to spread. In turn, the better rate of survival will be. Is the time greater or less than 2 years?
- PSA Doubling Time: The term refers to the time it takes for the PSA to double in value. The value measures the rate at which the PSA rises, and can be a very significant indicator of the aggressiveness of cancer. Men with a shorter PSA doubling time postoperatively are more likely to have more aggressive disease. In these cases, a more aggressive secondary treatment plan may be advised. Is the PSA doubling in less or greater than 10 months?
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Ive Had A Prostatectomy Am I At Risk Of Cancer Returning
Although all forms of cancer are technically a cellular mutation that cannot necessarily be prevented or controlled, there are factors that may increase the risk of prostate cancer recurrence, even after surgery. These include, but are not limited to, the following:
- Stage of Prostate Cancer
- If the prostate cancer was detected in a later stage, or if cancerous tissue or tumor growth is significantly progressed, a prostatectomy may be slightly less effective for the purposes of controlling future susceptibility to recurrence.
What Is Prostate Cancer Recurrence
Prostate cancer recurrence is the return of cancer after treatment and a period when no cancer activity could be detected. Local therapies with radical prostatectomy or radiation therapy are the two main ways to eliminate localized prostate cancer.
Both options are definitive treatments because they can cure prostate cancer altogether. However, local treatments are ineffective if cancer has spread outside the prostate gland. Here, other types of treatment are needed to target cancer cells located in other parts of the body.
Cancer cells remain after curative treatments because of positive surgical margins or metastasis if the disease is more advanced than initially thought. Prostate cancer cells can start to grow again from these sites.
Treatment relapse increases the possibility of developing advanced incurable disease that needs complex treatment decisions to manage. However, current clinical methods for treating recurred prostate cancer can result in both over-treatment and under-treatment due to a lack of adequate biomarkers to predict response.
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How Common Is Recurrence Of Prostatecancer
Early diagnosis and treatment can cure localized prostate cancer, and most men will remain free of cancer for many years, potentially the rest of their life. Despite these favorable statistics and improvements in the available local therapies, up to 40% of men treated for prostate cancer will experience a recurrence.
Since the majority of these patients are already elderly, they are more likely to die from causes other than prostate cancer. This age-dependent effect reduces the need for immediate clinical intervention following recurrence.
It is noteworthy that more than 90% of prostate cancer cases present while the cancer is either localized in the prostate gland or has spread to areas around the gland .
Therefore, these men can expect to live at least five years after diagnosis, which is a much better outcome than other cancers. Among the 10% with advanced disease, about 30% can expect to reach the five-year survival mark.
Higher Dose Radiation Raises Cure Rate
In the 2006 study conducted on nearly 5,000 radiation patients treated in nine academic U.S. radiation oncology departments standard doses for external beam radiation of the prostate were at or below 60 Gy.
Yet since then, radiation doses are often at or well above 70 Gy, due to the high-dose delivery systems in newer 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy , and Imaged Guided Radiation Therapy . Studies have shown that a higher dose of radiation significantly improves chances of the cancer not returning.
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Active Surveillance And Watchful Waiting
If your cancer is not causing any symptoms, is slow growing or is small and confined to the prostate, your doctor may suggest active surveillance or watchful waiting.
- Active surveillance means your doctor closely monitors your cancer using prostate-specific antigen tests, digital rectal exams, ultrasounds and biopsies. If a change indicates your cancer is becoming more aggressive, your doctor will talk with you about treatment options.
- Watchful waiting involves less testing. You and your doctor monitor any changes in your symptoms to determine if you need treatment.
Prostate cancer can take 10 or more years to spread enough to become life threatening, so if you already have a life expectancy of less than 10 years, it might not make sense to undergo aggressive cancer treatment, and your doctor might suggest active surveillance or watchful waiting.
These methods might also be appropriate if:
- You have a low-grade cancer and wish to defer treatment and potential side effects until treatment is necessary.
- You prefer not to undergo aggressive treatment.
- You want to avoid side effects of aggressive treatment.
- You have health problems that prevent you from being a candidate for other types of treatment.
Standard Care Post Treatment
After radiation treatment, doctors typically measure the PSA level every three months in a patient for the first year, and every six months thereafter. During the first year or two, patients normally experience a decline in their PSA blood test score. If the PSA level steadily decreases and stays relatively level after reaching its low point, then the treatment is considered a success.
However, if the PSA reaches a low point and then begins to steadily rise, the patient may be having a reoccurrence of the cancer, which could require additional treatments such as a hormonal blockade.
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Follow Up Treatment For Recurrent Prostate Cancer
When diagnosed with recurrent prostate cancer, its important to begin treatment as soon as possible. If you did not have a prostatectomy before, your doctor will likely recommend one now. This is important as recurrent prostate cancer is more aggressive and can result in the cancer spreading to lymph nodes and bone if not addressed quickly. In certain cases, when the only sign of recurrent cancer is an increased PSA level, your doctor may recommend a combination of radiation therapy, hormone therapy, chemotherapy, or a combination of treatment efforts.
If your prostate cancer has returned after undergoing hormone therapy, your body may no longer be responding to the hormones. If this is the case, it means one of two situations:
- Castrate-Resistant Prostate Cancer this is when your prostate cancer is still growing, regardless of the effect of hormone therapy on testosterone. CRPC may still respond to other types of hormone therapy.
- Hormone-Refractory Prostate Cancer this is when the prostate cancer is no longer able to be helped by any form of hormone therapy.
Regardless of if youve been diagnosed with prostate cancer, are experiencing recurrent prostate cancer, or are simply trying to take better care of your urologic care, working with a trusted urologist is essential. Always follow your doctors recommendations and dont hesitate to ask any questions you may have. During your treatment plan, along the way.