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Biochemical failure after treatment of prostate cancer

Biochemical failure after treatment of prostate cancer

Question

Dear OncoLink "Ask The Experts,"
A close friend of ours has been diagnosed with prostate cancer and had brachytherapy about 6 years ago. His PSA levels have been normal between that time and present, but a recent PSA test showed the level increased to 5.5. Bone scans show that there is some cancer present somewhere but cannot be pinpointed. They realize that further seeding cannot be done, and have been told about hormone therapy, which they do not want to pursue. What other treatment options are available to them at this time?  

Answer

David J. Vaughn, MD, Associate Professor of Medicine Abramson Cancer Center of the University of Pennsylvania, responds:

Biochemical failure after definitive treatment of prostate cancer is a complicated field. The first question is whether the biochemical recurrence is clinically significant or not. For example, some patients may have biochemical failure but be at extremely low risk of developing metastatic disease and can be observed. Others are a high risk of developing metastatic disease and need androgen ablation. Also, one must question whether this is a local recurrence (in the prostate) versus a systemic recurrence (metastasis). A bone scan should be able to localize a bone metastasis from prostate cancer. Thus, in this particular case, one needs more information. For many patients, if treatment is required, androgen ablation therapy is a standard approach.

There are also some experimental therapies being tested at the University of Pennsylvania using photodynamic therapy (PDT) for the treatment of local recurrence of prostate cancer after either external beam radiation therapy or seed implants. For more information on clinical trials, please visit the OncoLink Clinical Trials Matching service.