What Is Prostate Cancer?
The prostate gland is found in males, and it takes part in the formation of semen. When the cells in the prostate gland grow out of control, it is called prostate cancer.
What Is Recurrent Prostate Cancer?
Recurrent prostate cancer is when cancer returns even after the primary treatment that is intended to cure. Even if the cancer was initially treated, there is always a possibility of recurrence.
What Is the Survival Rate of Recurrent Prostate Cancer?
80 to 85 percent of all recurrent prostate cancers are detected at local or regional lymph nodes, where patients can be considered under stages 1,2 and 3. Patients at this stage have a cancer-free life for many years. But patients with distant or stage 4 prostate cancer can have an average survival of five years.
How Does Prostate Cancer Come Back?
The two main reasons for the recurrence of the prostate gland are:
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Some Cancer Cells Are Left Over During the First Treatment: Remaining cancer cells that are left overgrow over some time and cause symptoms. PSA (prostate-specific antigen) tests pick these up.
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Advanced Stage of Cancer: At the time of primary diagnosis, some of the cancer cells might have gone out of the prostate and may enter lymph nodes or other parts of the body like bones called distant metastases.
Where Could Prostate Cancer Reoccur?
It can reoccur in or more parts of the body like:
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Prostate gland (if it has not been removed by surgery).
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Prostate bed.
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Lymph nodes and bones.
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The area outside the prostate.
What Is Advanced Prostate Cancer?
Prostate cancer can spread to any other parts of the body, especially:
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Lymph nodes.
This is called advanced prostate cancer. Sometimes it is unclear where cancer spreads, but patients will show a rise in PSA levels. In advanced stages of cancer, hormone therapy is the most effective, but it also stops after some time.
What Is the Role Of PSA (Prostate-Specific Antigen)?
PSA is also known as a prostate-specific antigen. It is secreted by epithelial cells of the prostate gland. Prostate cancer recurrence is detected by PSA level in the blood after the treatment. It is advised to estimate the aggressiveness of recurrent prostate cancer.
But the location of recurrence is only detected by radiographic scans like CT (computed tomography) scans or bone scans. However, a certain amount of time is required for the cancer cells to appear in radiographic scans.
Levels of PSA:
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After Surgery: PSA levels should drop down to zero after surgery. If PSA levels rise above 0.2 ng/dl (nanograms per decilitre), the cancer is said to be recurrent.
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After Radiation Therapy: PSA levels rarely come down to zero after radiation. Here PSA level should drop down to a low number, which is called Nadir (lowest PSA level after primary androgen deprivation therapy). When PSA rises two points from Nadir, it is considered recurrent. If PSA is increasing doctor can advise for treatment even before the symptoms appear.
What Is the Treatment for Recurrent Prostate Cancer?
Treating recurrent prostate cancer is different than treating primary cancer. They are also called second-line treatments or salvage treatments. Every treatment has side effects, so a person needs to discuss with the doctor regarding the treatment plan.
Treatment is mainly of two types:
Treatments to Cure Cancer - These include:
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Surgery: Radical prostatectomy, the prostate is removed, and cancer inside it.
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External Beam Radiation Therapy: High-energy X-rays destroy cancer cells. This is not often considered in treatment because the high-energy rays can cause incontinence (loss of bladder control).
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High Dose Rate Brachytherapy: In this, thin tubes are inserted into the prostate, and a radiation beam is passed through these tubes for a few minutes into the prostate. Tubes are taken out post-treatment.
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Brachytherapy: Permanent seed brachytherapy involves inserting tiny radioactive seeds into the prostate.
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Cryotherapy: Uses extreme cold to destroy and kill cancer cells.
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HIFU: Also known as high-intensity focused ultrasound. Uses high-energy ultrasound waves to heat and kill the cancer cells in the prostate. It is a newer treatment.
Treatments Aimed At Delaying Cancer Growth. In this, one cannot get rid of cancer include:
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Chemotherapy: Anti-cancer drugs are used to kill the cancer cells that are present anywhere in the body. This can sometimes be combined with hormone therapy to improve the results.
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Hormone Therapy: Cancer cells in the prostate need testosterone to grow. Hence hormone therapy works by decreasing or stopping the amount of testosterone from reaching the cancer cells everywhere in the body.
One important test to be taken into consideration is the PSA levels of the patient. Increasing PSA levels are like a warning to the patient. In these cases, radiation or surgery may not work out, but hormone therapy combined with chemotherapy is a good option.
What Factors Are Taken Into Consideration While Treating Recurrent Prostate Cancer?
All the available treatments should not be advised to the patient. Several things need to take into account before suggesting a treatment plan, which includes:
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Treatment the patient has already taken for first or primary cancer.
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PSA levels of the patient, imaging tests.
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The general health of the patient.
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Where recurrent cancer has occurred in the body, like bones, liver, and lymph nodes.
What Is Castrate-Resistant and Hormone-Refractory Cancer?
Hormone therapy is considered effective in treating prostate cancer by shrinking the size and slowing down the growth, but it becomes less effective as time passes. Cancer that no longer responds to hormone therapy is known as “castrate-resistant and hormone-refractory cancer.
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Castrate-Resistant Prostate Cancer(CRPC): If the cancer is still growing despite hormone therapy, testosterone levels are kept as low as possible by removing the testicles. There can be hope that cancer might respond to other forms of hormone therapy.
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Hormone Refractory Prostate Cancer: If cancer no longer responds to hormone therapy.
If the prostate cancer is still growing despite hormone therapy, many other treatment options are available:
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Prostate Vaccine: Advised to patients with few or no symptoms. This reduces the PSA levels and increases the life expectancy of the patient.
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Other Forms of Hormone Therapy: Include anti-androgen therapy, estrogen (female hormones), Corticosteroids, Ketoconazole, Abiraterone, Enzalutamide, and Darolutamide.
Conclusion
Patients with prostate cancer should undergo regular follow-ups and be under cancer surveillance to detect possible early recurrence.
