Measurable PSA level despite surgery or radiotherapy
In the case of prostate cancer, as with most other forms of cancer in humans, the prospects of a patient being cured depends on how far the tumour has spread at the time of initial diagnosis. In most cases, a tumour confined to the prostate and regional lymph nodes at the time of surgery or radiotherapy can be treated successfully. However, if the tumour cells have spread further in the lymphatic system or bloodstream, further tumours may develop, which is known as recurrence.
In the case of prostate carcinoma, a relapse following surgery or radiotherapy is first indicated by a renewed increase in a patient’s PSA level (PSA recurrence) This usually occurs years before metastases appear in lymph nodes or bones. In the case of PSA recurrence following a prostatectomy, radiotherapy targeting the pelvic region can help to remove the remaining tumour cells. Alternatively, if radiotherapy was used as the first-line treatment, a salvage prostatectomy can remove remaining tumour cells in the pelvic region. Another option is to use radioactive labelling to identify metastases and remove them with the help of a gamma probe, which is known as PSMA-radioguided surgery. Otherwise, a decision might be taken to actively monitor the patient’s PSA level or begin androgen-deprivation therapy.
You should decide how to react to PSA recurrence in consultation with your urologist.
Cause for optimism, even with advanced cancer
If surgery or radiotherapy has not fully cured the prostate cancer and metastases appear at a later date, or if the initial diagnosis identifies metastases in the bones, lymph nodes or organs, drug therapy should be used to treat the tumour disease. In the latter case, it is important to carefully weigh up the potential benefits of additional local treatment (radiotherapy or prostate surgery).
As the male sex hormone testosterone regulates the growth of cancer cells, drug-based androgen-deprivation therapy can control the tumour and arrest its growth for a prolonged period, though it cannot cure the disease. Antiandrogen drugs in tablet form can block the effects of the hormone. This shields the tumour cells against testosterone without significantly reducing the level of testosterone in the blood.
One alternative to antiandrogen therapy is GnRH analogues and antagonists, which are a form of androgen-deprivation therapy administered as depot injections. These medications prevent the production of testosterone in the testicles. Although this method does not remove the tumour, it can slow or even stop the cancer’s progression.
Of course, testosterone deprivation entails certain side effects in the form of hot flushes, muscle wasting, osteoporosis, loss of libido (sexual interest) and potency, weight gain and anaemia. It is therefore vital to weigh up the circumstances in which drug therapy involving androgen deprivation appears medically sensible.