Does my choice of initial prostate cancer treatment preclude other treatments later on?
Answers from Erik P. Castle, M.D.
For most initial prostate cancer treatments, the answer is no. For instance, if your initial treatment is surgery to remove the prostate (prostatectomy), radiation therapy and hormone therapy may be options for you later, if necessary.
However, there is one exception. Prostatectomy isn't an option after radiation therapy for prostate cancer, except in very few specific cases.
Selecting the right treatment for prostate cancer depends on many factors. They include your overall health, your age, the size and spread of your cancer, the aggressiveness of your cancer, and how you feel about the potential side effects of treatment.
Treatment options include:
- Surgery (prostatectomy)
- Radiation therapy (either external beam radiation or radioactive seed implants, called brachytherapy)
- Hormone therapy
- Freezing therapy (cryosurgery)
- Active surveillance (watchful waiting)
Talk to your doctor about the pros and cons of each option before making a decision. Which initial treatment you choose can affect a later treatment choice, should it be needed because of recurring cancer.
Prostatectomy after radiation therapy or cryosurgery (salvage prostatectomy) is performed in only very select cases because the effects of radiation on the prostate and surrounding tissues make the procedure very difficult. Salvage prostatectomy carries a significantly increased risk of fecal and urinary incontinence, as well as a risk of injury to nearby structures, such as your rectum.
How widespread the recurring cancer is also plays a role in considering salvage prostatectomy.
Although salvage prostatectomy can be performed at specialized medical centers, it is often an option of last resort and determined on a case-by-case basis. Your doctor may recommend other treatments, such as hormone therapy, before considering salvage prostatectomy.
July 16, 2015
- Prostate cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed May 21, 2015.
- Wein AJ, et al., eds. Definitive therapy for localized prostate cancer: An overview. In: Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed May 27, 2015.
- Moul JW, et al. Rising serum PSA after radiation therapy for localized prostate cancer: Salvage local therapy. http://www.uptodate.com/home. Accessed May 27, 2015.
- Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. July 10, 2015.