According to American Urological Association guidelines published in the Journal of Urology in , men with these adverse features should be counseled about the potential advantages of adjuvant radiation therapy ART. Level I evidence reported in the Korean Journal of Urology in demonstrated improvements in biochemical and local recurrence with ART. However, significant debate persists about the relative risks and benefits of ART before evidence of cancer recurrence versus early salvage radiotherapy after recurrence, such as an increase in prostate-specific antigen PSA.
Radiation therapy, like all forms of treatment, may be associated with an increased risk of complications, including incontinence, bladder neck contracture, bladder and bowel symptoms, secondary procedures, and secondary malignancies. Therefore, reserving radiotherapy for those who will most benefit is of great concern. In an effort to learn more about this issue, urologist R. Jeffrey Karnes, M.
As detailed in an article published in Urology in , the research team created a matched cohort to compare oncologic outcomes in patients who received ART with those who underwent a wait-and-see approach. Patients were also matched by other variables that may have affected their oncologic outcomes, including age, year of surgery, Gleason score, preoperative PSA , site of positive surgical margins and DNA ploidy.
The cohort was composed of 76 men who received ART and 76 who did not. Additionally, there was no difference between the groups in overall survival. Matthew K. Many men with prostate cancer who have a radical prostatectomy prostate removal receive radiation therapy afterward to wipe out any residual cancer cells.
Alternatively, men can choose to delay radiotherapy and be monitored for evidence of prostate cancer activity, such as a rising blood level of prostate-specific antigen PSA. According to the findings of an analysis published online Sept. Since some men will never need radiotherapy, this means that by forgoing immediate treatment, they can avoid potential side effects like incontinence and bowel problems.
To do the study, researchers combined data from three randomized trials, involving a total of more than 2, men who had undergone a radical prostatectomy. The men were assigned either to receive immediate radiation or to be monitored and given radiation only if signs of cancer emerged.
The analysis showed that both approaches had similar outcomes, with no difference in cancer recurrence within five years.
The researchers suggested that monitoring with later radiation therapy only if needed now may be the preferred strategy. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Thanks for visiting. The prostate cancer vaccine sipuleucel-T Provenge is another option for men whose cancer is causing few or no symptoms. This might not lower PSA levels, but it can often help men live longer. For cancers that are no longer responding to initial hormone therapy and are causing symptoms, several options might be available.
Chemotherapy with the drug docetaxel Taxotere is often the first choice because it has been shown to help men live longer, as well as to reduce pain. The targeted therapy drug, rucaparib Rubraca , might be an option for men with a BRCA mutation whose castrate-resistant prostate cancer has already been treated with chemotherapy that includes a taxane and anti-androgens.
The targeted drug olaparib Lynparza is another option to treat men with a BRCA mutation whose advanced castrate-resistant prostate cancer has grown after the hormone therapy drugs, enzalutamide or abiraterone, have been tried. Bisphosphonates or denosumab can often help if the cancer has spread to the bones.
These drugs can reduce pain and even slow cancer growth in many men. Other medicines and methods can also help keep pain and other symptoms under control. If you are having pain from prostate cancer, make sure your doctor and health care team know about it. Several promising new medicines are now being tested against prostate cancer, including vaccines , monoclonal antibodies , and other new types of drugs.
Because the ability to treat hormone-refractory prostate cancer is still not good enough, men are encouraged to explore new options by taking part in clinical trials. Cancer that is thought to still be in or around the prostate If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
Cancer that clearly has spread If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Castrate-resistant and hormone-refractory prostate cancer Hormone therapy is often very effective at shrinking or slowing the growth of prostate cancer that has spread, but it usually becomes less effective over time.
Castrate-resistant prostate cancer CRPC is cancer that is still growing despite the fact that hormone therapy an orchiectomy or an LHRH agonist or antagonist is keeping the testosterone level in the body as low as what would be expected if the testicles were removed called castrate level s.
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