||If you or your loved one has just been told by the doctor that prostate cancer has returned or that it is not responding to therapy, you probably have a million questions: Why isn’t the treatment working? What does this mean? What options do I or my loved one have? You may be feeling anger, frustration, and even fear, but it is incredibly important that you work closely with the doctor as you or he considers his options. It is also incredibly important to maintain close contact with family and friends through this phase of treatment.
This section describes what to expect and what
treatment options are available to you or your loved one if prostate cancer has come back after receiving therapy or is not responding to hormone therapy. It also describes
questions you may want to ask the doctor, and where to
When you or your loved one was first diagnosed with prostate cancer, the doctor would have determined the likelihood that the cancer would come back after treatment based on the
PSA level, the Gleason score, and the stage of the cancer. The doctor would have then chosen the most appropriate treatment option, weighing the risks of side effects and the probability of successfully treating the cancer.
If you or your loved one underwent surgery or received radiation therapy, the doctor should be monitoring PSA levels and performing a DRE every 6 months or every 3 months minimum with a Gleason score of 7 or above to ensure that the cancer has not returned. If the doctor discovers that the PSA levels are rising or can detect cancer growth in the prostate, he will likely suggest either
external beam radiation therapy or
hormone therapy to slow down and destroy the cancer cells.
High Intensity Focused Ultrasound
(HIFU) is a new treatment option that has shown success.
If you or your loved one has already received hormone therapy, but PSA levels continue to rise or the doctor can detect cancer growth, the cancer may no longer be sensitive to treatment and is called
hormone-resistant or androgen-independent prostate cancer. Some prostate cancers do not respond to hormone therapy, and some that once responded to hormone therapy may lose their ability to do so as they grow.
If the cancer is no longer responding to hormone therapy, the doctor may recommend either
systemic radiation therapy or
chemotherapy to destroy cancer cells throughout the body. If the cancer cells are detected in other tissues, the doctor may also prescribe medications, such as
Nizoral® (ketoconazole) which is often given in combination with hydrocortisone, to slow cancer cell growth and reduce pain associated with cancer cell growth in the bones.
There are also several emerging treatments for hormone-resistant prostate cancer that are being tested in
clinical trials. You or your loved one may be eligible to participate in these trials, and although it is not known whether a particular treatment will be successful, you or he will be cared for and closely monitored by a team of experts during the trial. The doctor can explain more about specific clinical trials that are going on now and the risks and benefits of participating in a clinical trial.
If your loved one has experienced a relapse or is not responding to his current treatment, it can be frustrating and frightening. Fortunately, new therapies are under development, and some of these hold promise as therapy options. This section discusses the current treatment options for cancer that has returned after treatment or for cancer that is no longer responding to hormone therapy, as well as some of the new prostate cancer treatments under development. It also provides information on clinical trials of experimental therapies.
When prostate cancer has spread to other tissues in the body, particularly the bones, it can cause pain. External beam radiation or systemic radiation therapy such as samarian-153
(Quadramet®) and strontium-89 (Metastron®) can reduce bone pain caused by metastases. Bisphosphonate medications, usually pamidronate
(Aredia®) and zoledronic acid (Zometa®), can slow the growth of bone metastases and reduce pain.
Xgeva™ (denosumab) is indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors. Xgeva is a fully human monoclonal antibody that binds to RANK Ligand, a protein essential for the formation, function and survival of osteoclasts (the cells that break down bone). Xgeva prevents RANK Ligand from activating its receptor, RANK on the surface of osteoclasts, thereby decreasing bone destruction.
Your pain may also be attributed to a spinal fracture, as prostate cancer cells often metastasize to the spine and make it more vulnerable to fracture. The individual bones in your spinal column, called vertebrae, are less dense and more “spongy,” yet as cancer spreads (metastasizes), it can either abnormally build additional bone or break it down further. It is difficult to feel changes in your bones while they are happening. In fact, many people are unaware that there is anything wrong until a fracture occurs. Learn more about spinal fractures and treatment options here.
The following is a list of questions to ask the doctor if you or your loved one has been diagnosed with hormone-resistant prostate cancer or has experienced a relapse. It may be worthwhile to audio record your conversation with your doctor so that you can review the answers to each question and be able to make informed decisions about treatment options.
- Has the cancer spread and if so, how far?
- What are the treatment options?
- What are the benefits and risks of the type of therapy you are recommending?
- What side effects are associated with the type of therapy that you are recommending?
- Are there other treatment options available?
- Can you refer us to a colleague or another expert for a second opinion?
- What can I do to improve the success of my or my loved one’s therapy?
- What kind of follow-up can we expect after treatment?
- What are the short-term and long-term side effects of treatment?
- Where can I find out more about hormone-resistant prostate cancer and the treatment options?
- What can you tell me about new experimental treatment options?
- Should I or my loved one consider participating in a clinical trial?
Read a list of questions for urologists, radiation oncologists and medical
oncologists, as compiled by an experienced prostate cancer patient.
You can also post questions for physicians and join discussions on specific topics about prostate cancer on the
Physician-to-Patient (P2P) bulletin board located in the
Online Communities: Prostate Pointers section of this Web site.