Radiation Therapy For Prostate Cancer
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
Prostate Cancer Recurrence: How To Know And What To Do
Prostate cancer is the second most common cancer in men globally, with an annual incidence of over 1 million . Its associated mortality accounts for approximately 3.8% of all cancer deaths in men .
In most cases, prostate cancer recurrence serves as the primary driver of mortality. This link relates to the clinical features of recurrence, including an increased risk of incurable metastasis and reduced therapeutic options.
Radical treatment can be curative for localized prostate cancer, but some patients present with more advanced diseases and a significant proportion of those who die from it.
The introduction of salvage therapies such as hormone therapy, radiation therapy, surgery, and chemotherapy in such situations can improve clinical outcomes . However, resistance and inadequacy of predictive biomarkers highlight the need for novel therapeutic approaches for recurrent prostate cancers.
After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
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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.
Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has recurred .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected side effects of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
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How Common Is Recurrence
The recurrence of prostate cancer depends on when it was caught and treated the first time. If your doctor was able to remove the cancer while it was still confined in the prostate gland, your chances of recurrence are fairly low. If your cancer spread before treatment, such as in the case of about 10% of men, recurrence is more likely to occur. Recurrence, therefore, occurs if not all of the cancer cells were treated the first time or if the cancer was more advanced than originally believed.
Treatment Of Recurrent Prostate Cancer
It is possible that prostatecancer comes back after you have been treated. This is known as recurrence. The cancer may come back in the prostate, in tissue around the prostate or pelvic lymph nodes, or in other parts of the body.
The follow-up treatment pathway depends on where the cancer is. Your doctor will recommend imaging tests such as CT, MRI, PET scan or bone scans to locate the tumour, identify its characteristics, and determine treatment.
If you have been treated with radical prostatectomy and the PSA level in your blood rises, this could be a sign of recurrence. Your doctor may recommend salvageradiation therapy. In this procedure, the area where the prostate was located will be radiated to kill cancer cells. If radiation therapy is not the best option for you, your doctor can recommend hormonal therapy.
If your cancer was treated with radiation therapy, your doctor may recommend to treat recurrence with radical prostatectomy. If the PSA level rises quickly, or you have symptoms, hormonal therapy will be recommended. In some countries, brachytherapy is available to treat recurrence as an alternative to hormonal therapy.
If you have been treated with experimental techniques, discuss with your doctor which treatment option is best for you.
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Prostate Cancer In Vivo Models
Orthotopic prostate cancer models are suitable for testing the efficacy of drug compounds against primary tumor growth in the proper tissue microenvironment. They involve a surgical procedure where prostate cancer cells are inoculated into the ventral prostate through the dorsal lobe, leading to development of a primary tumor to the site of inoculation.
Pharmatest offers orthotopic prostate cancer models with the androgen receptor positive, PSA producing LNCaP cell line, and with the androgen receptor negative PC-3 cell line that also develops metastases to prostate-draining lymph nodes. Endpoint measurements include tumor size, serum PSA levels , and metastasis frequency and histology .
Several additional parameters can be studied by immunohistochemistry, including angiogenesis, hypoxia, proliferation rate and apoptosis.
There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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Understanding The Recurrent Prostate Cancer
Recurrent prostate cancer is when prostate cancer returns after the initial treatment or partial to complete remission has occurred. This is due to the reemergence of surviving prostate cancer cells that have grown large enough to be detected.
Following a prostatectomy, your prostate-specific antigen levels being to decrease. Eventually, they are no longer detectible, which is an indication that prostate cancer is no longer present. However, there is no clear reference for a normal PSA. It differs between men and can be affected by a number of factors. Following your initial prostate cancer treatment, PSA levels should stabilize and be low enough to where theyre not detected on blood tests. In some cases, PSA levels begin to rise again, indicating a need for further tests.
Even if youve had a prostatectomy, prostate cancer can recur in the immediately surrounding tissue, lymph nodes, seminal vesicles, muscles that control urination, the rectum, the wall of the pelvic, or metastasize into lymph nodes and bones further away.
Treating Advanced Prostate Cancer
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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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
Who Is More Likely To Have Prostate Cancer Recurrence
In general, the further your cancer has spread and the more aggressive it is, the more likely it is to recur. Specific factors include:
- Tumor size: In general, the larger the tumor, the more likely it is to recur.
- Gleason score: A higher Gleason score means a more aggressive cancer and a higher rate of recurrence.
- Cancer staging: Staging refers to how far the cancer has spread. Higher stage cancers have spread further at initial treatment and have higher rates of recurrence.
- Involvement of the lymph nodes: Prostate cancer that has entered the lymph nodes prior to treatment is more likely to recur.
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Prostate Cancer Recurrence After Prostatectomy: Why Does It Happen And How Do We Treat It
Filed in Life After Treatment
The concept of prostate cancer recurrence after prostatectomy puzzles many patients. A frequently asked question is how can the cancer come back if the prostate has been removed? The explanation is that, as with any cancer, if cancerous cells migrate out of the organ in which they arose before the organ is removed , they can settle and grow elsewhere. These migrating cells are called metastases, secondary deposits or secondaries.
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.
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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 surveillanceÃ¢â¬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.
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:
- Some cancer cells were left behind after surgery or radiation therapy.
- Cancer cells had already spread to your lymph nodes or other organs before you had surgery.
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.
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Managing Recurrent Prostate Cancer
|PEER-TO-PEER CLINICAL CONVERSATIONS|
|The EMBARK Study: A Phase 3 Randomized Study of Enzalutamide Plus Leuprolide and Enzalutamide Monotherapy in High-Risk Nonmetastatic Hormone-Sensitive Prostate Cancer with Rising PSA After Local Therapy|
|Stephen Freedland, MD|
|Stephen Freedland presents the manuscript entitled, “A Phase 3 Randomized Study of Enzalutamide Plus Leuprolide and Enzalutamide Monotherapy in High-Risk Nonmetastatic Hormone-Sensitive Prostate Cancer with Rising PSA After Local Therapy: EMBARK Study Design”.|
|Who Needs Early Salvage RT and Who Needs Adjuvant RT in 2022? APCCC 2022 Presentation|
|Kosj Yamoah, MD, Ph.D.|
|At the 2022 Advanced Prostate Cancer Consensus Conference, Kosj Yamoah presented on who needs early salvage RT and who needs adjuvant RT in 2022.|
|Biochemical Recurrence After Definitive Radiotherapy of the Prostate What Are the Local Treatment Options? APCCC 2022 Presentation|
|Jochen Walz, MD|
|At the 2022 Advanced Prostate Cancer Consensus Conference Hybrid Meeting, Jochen Walz presented on biochemical recurrence after definitive radiotherapy of the prostate focusing on local treatment options.|
|Local and Focal: Whats Next in Salvage Therapy? – Discussion|
What Factors Determine The Likelihood Of Recurrence
Several clinicopathological factors influence the risk of treatment relapse and how fast it occurs after treatment.
Especially, tumor characteristics observed at diagnoses, such as tumor stage and size, play essential roles in selecting treatment methods and predicting long-term treatment outcomes. Studies have consistently linked the following factors with an increased risk of recurrence:
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How To Lower The Risk Of Prostatecancerrecurrence
Lifestyle changes can help reduce your risk of prostate cancer recurrence. They range from engaging in regular physical exercise to taking nutritional supplements.
However, further research studies are needed to confirm the actions of many preventative strategies for prostate cancer recurrence. We discuss some of these approaches below.
- Undertake regular physical activity. Research suggests that regular exercise after treatment significantly reduces the risk of prostate cancer mortality compared to control groups who do not exercise.
- Maintain a healthy weight. Men who are overweight or obese at diagnosis tend to have worse treatment outcomes than those at a healthy weight.
- Quit smoking. Smoking increases the rate of prostate cancer recurrence and mortality.
- Nutrition and supplements. A healthy diet rich in vegetables and low in animal fat promotes overall health. The benefits of a healthy diet go beyond the prostate and other cancers. Some dietary supplements may help reduce the risk of prostate cancer recurrence, but further research is needed.
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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