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What are the treatments for recurrent prostate cancer?

A rising prostate-specific antigen (PSA) level after treatment for prostate cancer suggests the recurrence of cancer. Magnetic resonance imaging (MRI) has been shown to detect recurrent cancer both in the surgical bed and radiation therapy field, and also in the bones and lymph nodes. Spectroscopy and perfusion modeling can increase detection. However, the ability of doctors to detect this prostate cancer is relatively low.

Active surveillance is appropriate for men with low-volume, low-grade disease. MRI has two advantages: it can screen for missed areas that look suspicious for high-grade cancer, and it can also provide an imaging baseline to evaluate for follow-up. There’s a lot of interest in MRI replacing biopsy, but this is currently not standard procedure, and MRI does sometimes miss tumors.

Dr. Marc B. Garnick, MD
Hematologist & Oncologist

Biochemical recurrence is a post-treatment increase in prostate-specific antigen (PSA) level, indicating that prostate cancer has recurred or spread following the original treatment for prostate cancer. It is also called biochemical failure. It can occur in up to 35 percent of men who have already received treatment with radical prostatectomy or radiation therapy. The only evidence of cancer recurrence in these men is an elevation of the PSA level.

Taking cholesterol-lowering drugs such as statins may prevent prostate cancer recurrence in men who undergo surgery for the disease, a study suggests.

Researchers followed 1,319 men who had a radical prostatectomy at one of four Veterans Affairs hospitals; 236 of these patients were taking statins at the time of the surgery. Statin users tended to be Caucasian, older and more overweight than nonusers. But even after adjusting for those factors, men who took statins were 30 percent less likely to experience a relapse than those who did not take the drugs. Researchers defined recurrence as a 0.2 nanograms per milliliter (ng/mL) rise in prostate-specific antigen (PSA) levels.

The statin dose appeared to make a difference as well. Daily doses equivalent to 20 milligrams (mg) of the drug simvastatin reduced the recurrence risk by 43 percent, while doses greater than 20 mg slashed the risk by 50 percent. Patients taking less than 20 mg did not see any benefit in keeping prostate cancer at bay.

Studies about statin therapy and prostate cancer risk have arrived at varying conclusions, but many have found that statins reduce disease risk, severity or recurrence. Several mechanisms have been identified; they involve altering the expression of cancer genes, affecting the growth of blood vessels or the ability of cancer cells to adhere and spread, and promoting apoptosis (programmed cell death). Some results also suggest that statins may strengthen the effects of standard cancer drugs or radiation.

Of note, researchers did not collect information about patients' diet and exercise habits or their smoking history, making it unclear if statins alone affected the risk of cancer recurrence. The study size was also relatively small. For those reasons, it's too soon to draw any solid conclusions about the potential impact of statins on prostate cancer or to prescribe statin therapy to prevent the disease or its recurrence. Still, men who need a statin to protect their hearts may be pleased to learn that prostate protection is a possible "side effect."

Recurrent prostate cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the prostate or in other parts of the body.

There are several options available for treatment of recurrent prostate cancer, depending in part on what treatment was used previously. Radiation therapy with or without hormone therapy may be used if surgery was the initial treatment; surgery (prostatectomy), cryotherapy or brachytherapy may be used if radiation was the first treatment. Chemotherapy may be suggested. Biologic therapy, which uses a vaccine called sipuleucel-T, is also a possibility for those whose cancer causes mild or no symptoms. If the cancer is aggressive or has spread to the lymph nodes, bones or other parts of the body, other treatments may be required, including medications like denosumab for pain. Your doctor may also suggest joining a clinical trial if your recurrent prostate cancer is not responding to treatment; these might involve newer forms of existing therapies, like anticancer drugs, hormone therapy and radiation treatment.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.