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Prostate Cancer: Treatments by Stage

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Recurrent Prostate Cancer continued...

Usually, the same type of treatment is not an option. For example, men who have already had radiation therapy cannot have radiation therapy again to the same area.

If the cancer is still localized to the area of the prostate, a second attempt at curative therapy may be possible. If you've had a radical prostatectomy, radiation therapy may be helpful. If your initial treatment was radiation, radical prostatectomy may be an option in selected cases, although it carries a high risk for potential side effects. Cryosurgery may also be an option if the cancer is still localized.

If the cancer has spread to other parts of the body, hormone therapy is probably the most effective treatment. Your doctor may suggest radiation therapy (using external beams or radiopharmaceuticals) or other treatments (medicines such as bisphosphonates) to relieve symptoms of bone pain. Or he or she may consider chemotherapy or other treatments under study in clinical trials.


Hormone-Refractory Prostate Cancer (HRPC)

Cancer that is no longer responding to hormone therapy such as LHRH analogs or anti-androgens is considered hormone-refractory. This can be difficult to treat. Other drugs that affect hormone levels, such as abiraterone, and older agents including ketoconazole, megestrol, or diethylstilbestrol (DES), are sometimes effective.

At one time, doctors thought chemotherapy was not effective against prostate cancer. But in recent years, this notion has been challenged. Several chemotherapy drugs seem to reduce PSA levels and improve quality and sometimes duration of life.

Recent studies of chemotherapy regimens that include the drug docetaxel show they can improve survival by several months. Jevtana seems to work in some patients after docetaxel stops working. Mitoxantrone and Prednisone, as well as Xtandi (enzalutamide), also have activity against prostate cancer in this setting.

Provenge is a vaccine for hormone-resistant prostate cancer that helps extend survival in men with hormone-resistant disease. Studies show that after starting treatment, about half of men are still alive two years later.

The medicine Zytiga is taken with the steroid Prednisone and is meant for men with hormone-refractory cancer that has spread to other parts of the body. Common side effects include high blood pressure, fatigue, joint swelling or pain, diarrhea, and fluid retention.    

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