Recurrent cancer is cancer that comes back after treatment. In prostate cancer, the selection of further treatment depends on many factors, including previous treatment, site of recurrence, coexistent illnesses, and individual patient considerations.
Refractory cancer (cancer that does not respond to treatment) and recurrent cancer require similar treatments. The cancer may fail to respond when it is first treated or it may become resistant during treatment, and may be called resistant cancer.
Both recurrent and refractory cancer may cause a patient to experience pain, fatigue and weight loss. The goal of treatment at this point switches from curing the cancer to slowing it down and relieving symptoms.
It is important to note that many men outlive their prostate cancer, even those with advanced disease. Prostate cancer often grows slowly, and there are now effective treatment options and clinical trials for finding new treatments that extend life even further, as well as control the symptoms of advanced cancer.
Living with Recurrent Prostate Cancer
"A patient whose prostate cancer returns after first-line treatment still has options that may control the spread of his disease," says Donald L. Trump, MD, President and CEO of Roswell Park. Recurrent prostate cancer is not curable, "but with the right treatment, it is very likely a patient can live, with good quality of life, for many years."
The process begins with the PSA test, which is used following treatment.
"PSA velocity, or how quickly PSA levels rise, offers a clue into how quickly the tumor is returning," continued Dr. Trump. "Once we learn this, we can then tailor the treatment." Options for this first phase include active surveillance to track the PSA velocity, vitamin D supplementation, and even anti-estrogen options such as faslodex that have been shown to slow the speed at which the tumor returns.
By the time there are clinical signs of the recurrence, such as bone metastases, men can start androgen deprivation therapy (ADT) to starve the tumor of male hormones that encourage these cells to grow. "In addition to using well-known hormone therapies such as casodex and lupron to fight recurrence, Roswell Park is investigating the addition of ketoconazole and calcitriol (oral vitamin D) to our regimen. Although it is best known as a treatment for antifungal conditions, ketoconazole blocks the minute amounts of testosterone produced by the adrenal glands which may help slow the return of tumor even more."
Prostate cancer that returns after ADT is known as hormone-refractory disease. This means that the cancer is growing regardless of the hormone levels in the body. At this point, chemotherapy becomes an option along with other therapies to support the patient. "Our goal is to continuously attack the disease on all fronts, while helping the patient maintain a high quality of life. There are new clinical studies opening all the time, so there are always options, even for patients who have exhausted all previously known solutions," said Dr. Trump.
"I have had patients live with their cancer for over 15 years," he said. "I do not want to paint an unrealistic portrait with that statement; some men will succumb to their cancer. However, with our team approach, the new research into advanced prostate cancer and the knowledge we've gained over the span of my career, I do believe that recurrent prostate cancer can be viewed as a chronic condition for many men."
Androgen Deprivation Therapy
Androgen Deprivation Therapy (ADT), sometimes referred to as hormone therapy, is often used for patients whose prostate cancer has spread beyond the prostate or has come back (recurred) after treatment. It can also be combined with radiation therapy for certain stage T3 cancers. There are several methods used for hormone therapy, including orchiectomy, luteinizing hormone–releasing hormone (LH–RH) agonists, and anti–androgens.
The goal of ADT is to block the effect of the male hormones. The main androgens are testosterone and dihydrotestosterone (DHT). Androgens are produced mainly in the testicles and cause prostate cancer cells to grow. Lowering androgen levels or blocking their action can make prostate cancers shrink or grow more slowly. But hormone therapy alone does not cure the cancer.
Some prostate cancers do not respond to hormone therapy. These are called androgen–independent cancers. Often prostate cancers respond to hormone therapy for a few years before becoming androgen–independent. Less often, prostate cancers may be androgen–independent at the time they are diagnosed.
Click here to learn more about Androgen Deprivation Therapy (ADT).
