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Prostate cancer treatment: Does initial treatment preclude others later?
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/prostate-cancer-treatment/AN01850
- With Mayo Clinic urologist
Erik P. Castle, M.D.
read biographyclose windowBiography of
Erik P. Castle, M.D.
Erik P. Castle, M.D.
Dr. Erik Castle is a board-certified urologist who joined the Mayo Clinic staff in Arizona in 2007.
Dr. Castle is an associate professor of urology at College of Medicine, Mayo Clinic, and a senior associate consultant in the Department of Urology, where he also is assistant residency coordinator.
He was an assistant professor in the Department of Urology at Tulane University in New Orleans from 2004 to 2006 after serving as a clinical instructor/fellow at Mayo Clinic in Arizona for one year.
Dr. Castle's research interests include prostate cancer, bladder cancer and kidney cancer. He is the director of the Desert Mountain Prostate Cancer Research Fund and is the principal investigator of Castle labs housed at the Samuel C. Johnson Medical Research Building at Mayo Clinic in Arizona. His basic science research is focused on novel secondary hormonal therapies of prostate cancer as well as genomics of prostate and bladder cancers.
His surgical expertise includes laparoscopic urology, robot-assisted radical prostatectomy with nerve sparing, robot-assisted radical cystectomy with neobladder, robot-assisted retroperitoneal lymph node dissection, robot-assisted partial nephrectomy and other robotic urologic oncology procedures. He has performed many of these procedures as demonstrations internationally. He is a member of the American Association of Clinical Urologists, the American Urological Association, the Endourological Society, and the Society of Laparoendoscopic Surgeons. He is past president of the international Society of Urologic Robotic Surgery. He is also the director of the international laparoscopic nephrectomy courses throughout Mexico on behalf of the American Urologic Association.
Risk factors (2)
- Flaxseed: Does it affect risk of prostate cancer?
- Vasectomy: Does it increase my risk of prostate cancer?
Tests and diagnosis (1)
- Prostate cancer: Does PSA level affect prognosis?
Complications (1)
- Prostate cancer metastasis: Where does prostate cancer spread?
Treatments and drugs (3)
- Prostate cancer treatment: Does initial treatment preclude others later?
- Ginger for nausea: Does it work?
- Prostate cancer brachytherapy: Can I pass radiation to others?
Alternative medicine (1)
- Pomegranate juice: A cure for prostate cancer?
Prevention (1)
- Frequent sex: Does it protect against prostate cancer?
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Question
Prostate cancer treatment: Does initial treatment preclude others later?
Does my choice of initial prostate cancer treatment preclude other treatments later on?
Answer
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)
- Chemotherapy
- 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.
Next questionGinger for nausea: Does it work?
- 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.
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