Dr. Fecteau on Salvage Therapy for Recurrent Prostate Cancer

Ryan Fecteau, MD, PhD, radiation oncologist, genitourinary cancers, Duke Cancer Institute, discusses the navigation of salvage treatment options for patients experiencing isolated prostate cancer recurrence.

Patients with prostate cancer who have undergone radical prostatectomy and have a higher risk of disease recurrence are usually directed towards lymph node sampling or dissection and monitored for high prostate-specific antigen (PSA) levels in peripheral blood, Fecteau begins. Potential recurrence can sometimes be detected with PSMA-PET scans, which have become more routinely incorporated into standard clinical practice, he explains. Although not all patients in this population will present with isolated tumor recurrences, an increasing number are experiencing these failures in the pelvic lymph nodes in recent years, Fecteau states.

Accordingly, identifying the best follow-up treatment for these patients has become an area of focus for clinical practice, Fectau continues. Several combinations of systemic therapy, hormone therapy, and radiation have been identified as potential options for these patients. Hormone therapies such as androgen deprivation therapy (ADT) could be utilized with or without radiation, For example, patients with persistent disease might benefit from targeted radiation therapy without other agents. This could potentially prolong the need for subsequent hormone therapy, Fecteau says.

A limited amount of retrospective data exist in support of each option. More research is needed to determine which treatments are viable and effective in these patients, Fecteau notes. This could be accomplished through a larger, randomized-controlled trial, he suggests.

With this lack of large-scale, comparative data, individual patient factors should be taken into consideration when determining a treatment approach. These include age, personal values, preference for ADT vs radiation therapy, and quality of life, Fecteau concludes.