Standard Treatment for Prostate Cancer Recurrence
Initial Treatment Options for Recurrent Prostate Cancer
- The American College of Physicians recommends bilateral orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonists as the first-line treatments for recurrent prostate cancer, with nonsteroidal antiandrogen (NSAA) monotherapy as an alternative option 1, 2, 3
- Combined androgen blockade (CAB) may provide improved overall survival, though with potentially increased adverse effects, according to the American Urological Association 1, 2
Treatment Based on Type of Recurrence
For Local Intraprostatic Recurrence After Radiotherapy
- Local salvage with reirradiation is usually appropriate for isolated intraprostatic recurrence, as recommended by the European Association of Urology 4, 5
- Focal salvage should be pursued when confidence in focal recurrence can be confirmed via multiple radiographic and tissue sampling modalities, according to the European Association of Urology 5
For Biochemical Recurrence (Rising PSA)
- For patients with biochemical recurrence and positive PSMA PET findings but negative conventional imaging, novel hormonal agents such as enzalutamide are recommended by the American Society of Clinical Oncology 6
For Metastatic Recurrence
- Standard hormonal therapy (ADT) is recommended for stage N1/M0 (nodal metastasis) and M1 (distant metastasis) disease, according to the American Urological Association 7, 8
Timing of Androgen Deprivation Therapy
- The optimal timing of ADT initiation remains controversial, with no clear overall survival advantage for immediate versus deferred therapy, as stated by the American College of Physicians 2, 3
- Immediate ADT results in a moderate decrease (17%) in relative risk for prostate cancer-specific mortality but a moderate increase (15%) in relative risk for non-prostate cancer-specific mortality, according to the American Society of Clinical Oncology 3
Intermittent versus Continuous ADT
- Currently, data are insufficient to support the routine use of intermittent androgen blockade outside clinical trials, as recommended by the American Urological Association 2, 3
Important Considerations and Monitoring
- PSA measurements should be performed every 3-4 weeks initially to assess response to therapy, as recommended by the American Society of Clinical Oncology 6
- Regular imaging follow-up with CT scans and bone scintigraphy should be considered to assess response, according to the American College of Radiology 6