The same four definitive treatment options available initially for localized prostate cancer are also available for treating a possible recurrence of localized prostate cancer.. These treatment options are High Intensity Focused Ultrasound (HIFU),Cryoablation (freezing),Radiation (various forms) and surgery (various types). The four categories of treatments have similar survival benefits but the first three have less complications than surgery which also has the biggest negative impact on Quality of Life (QOL) issues.
After definitive therapy for for localized prostate cancer your PSA (prostatic specific antigen) should nadir to about 0.1-0.2ng/ml but about 1/3 of treated men will develop a rise in their PSA at some time.
A rising PSA may not always mean a recurrence of the prostate cancer or an incomplete treatment of the cancer as a temporary “bump” or “bounce” in your PSA after radiation is common.
However,all persistent PSA rises should be evaluated early with a trans-rectal prostate biopsy. After any prostate biopsy you should demand to have your slides sent to a reference laboratory for validation. This is very important as the majority of the prostate biopsies are read by general pathologists and because there is a certain degree of subjectivity involved in determining the presence of prostate cancer,the amount of cancer, as well as the Gleason score,validation is important.
If a man is diagnosed with a recurrence after radiation he is usually offered only active surveillance (AS) or androgen deprivation therapy (ADT) or so called “hormone shots”. Unfortunately,long term ADT has significant downsides with side effects as well as bone wasting and metabolic syndrome events bringing about a negative impact on QOL. HIFU and Cryo are ideal definitive treatment options in men with an early localized prostate cancer recurrence after radiation or in those men where the treatment was incomplete after radiation.
Recurrent prostate cancer after surgical removal is not uncommon either and a man and his spouse are quite mistaken to think that after surgical removal that they can forget about a cancer recurrence because the prostate is gone. Not so. In fact,after surgery (which includes robotics),somewhere between 20-40% of men will have positive margins to their specimens which means that prostate cancer was left behind. Some of these men will be offered AS. Others will be offered radiation,either adjunctive or salvage, to the prostatic bed.
However,if there is a nodule palpable in the prostatic bed and it is proven to be a cancerous recurrence then HIFU may be used to treat this definitively.
The treatment of recurrent cancer in the prostate after radiation or surgery is possible once more using HIFU or Cryo.
Unfortunately,few urologists or radiation oncologists are familiar with or have had the training in the minimally invasive therapies of HIFU or Cryoablation. HIFU is the most precise of these options,as well as being non surgical and non radiation and performed as an outpatient. Furthermore,unlike Cryo or radiation where the treated prostatic cancer tissue remains within the prostatic capsule, after HIFU treatment the treated cancerous tissue is expelled over time during urination. This particular feature of HIFU treatment for prostate cancer may help minimize the chances of a recurrent cancer developing.
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