Does my choice of initial prostate cancer treatment preclude other treatments later on?
Answers from Erik P. Castle, M.D.
Generally speaking, no. But first, some background information.
Selecting the right treatment for prostate cancer depends on many factors. They include your overall health, your age, the size and spread of the 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)
- Heating therapy (high-intensity focused ultrasound)
- 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 may not affect a later treatment choice, should it be needed because of recurring cancer. However, prostatectomy after radiation therapy or cryosurgery (salvage prostatectomy) is performed in only very select cases because of the significantly increased risk of fecal and urinary incontinence. 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. In general, prostatectomy is not an option for men who have previously received radiation therapy or cryosurgery, and other treatments, including androgen deprivation therapy (ADT), may be tried before a salvage prostatectomy.
Jul. 07, 2012
See more Expert Answers
- Nguyen PL, et al. Cancer. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: A systematic review of the literature. 2007;110:1417.
- Moul JW, et al. Rising serum PSA after radiation therapy for localized prostate cancer: Salvage local therapy. http://www.uptodate.com/index. Accessed June 8, 2012.
- Kimura M, et al. Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy. British Journal of Urology International. 2010;105:191.
- Cox JM, et al. Salvage therapy for prostate cancer recurrence after radiation therapy. Current Urology Reports. 2009;10:199.
- Castle EP (expert opinion). Mayo Clinic, Scottsdale/Phoenix, Ariz. April 27, 2010.
- Darwish OM, et al. Management of biochemical recurrence after primary localized therapy for prostate cancer. Frontiers in Oncology. 2012;2:1.
- Chade DC, et al. Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: A systematic review of the literature. European Urology. 2012;61:961.