Salvage Therapy: What Does It Mean for Prostate Cancer Patients?

One of the most underutilized therapies in the battle against prostate cancer is called salvage therapy.

Richard Beven-Thomas Urologists at USMDPCC
By: Dr. Richard Bevan-Thomas

This name can conjure up all kinds of images. But let's get to what this treatment really is and how it helps treat the prostate cancer patient.

Salvage therapy for prostate cancer is technically defined as any therapy utilized to cure cancer after a failure of the initial treatment. This can be salvage radiation, salvage radical prostatectomy, salvage cryoablation and salvage HIFU. Salvage radiation is perhaps the most commonly utilized of all the modalities, and it is most commonly used for patients with a localized recurrence of cancer in the bed of the prostate after a radical prostatectomy. Salvage radiation is most commonly recommended in two instances: 1. If the patient comes in with a rising PSA after surgery with a positive margin (cancer at the margin of the prostate seen once the prostate has been removed), or 2. Cancer that has spread locally outside of the prostate is confirmed after analyzing the prostate upon removal. Although the cure rate can be as high as 70 percent, it is imperative that these patients are treated early before the cancer has a chance to spread to distant areas. The most ideal candidate has a PSA less than 0.2.

Salvage prostatectomy continues to remain an option for select men after radiation, cryoablation or HIFU, but continues to remain a complex surgery. It is often more difficult in men after radiation therapy because the tissue surrounding the prostate becomes scarred from radiation and increases the side effects such as impotence and incontinence. This continues to evolve, however, as radiation techniques become more precise and in select patients, this may be a reasonable option to remove any persistent cancer by removing the prostate.

Salvage cryoablation continues to remain the most common procedure for men with recurrent prostate cancer after radiation therapy or hormonal therapy and even for men with recurrent cancer after HIFU and Cryoablation. The procedure involves freezing and thawing the prostate, destroying the prostate and any cancer within the prostate. This is a technically challenging procedure offered at USMD Prostate Cancer Center. Unfortunately, salvage cryoablation continues to remain underutilized as a treatment option. One study has estimated that less than 10 percent of eligible men were even aware that such an option existed. With the development of third generation cryoablation technology and variable probes to individualize the length of the ice balls to treat the prostate, the side effects associated with salvage cryoablation have also significantly decreased. Salvage cryoablation continues to remain one of the best FDA approved minimally invasive options for men with recurrent localized prostate cancer.

In summary, there is hope for men with a rising PSA after initial treatment for prostate cancer. If the cancer is confined to the prostate or to the prostate bed, there is still an excellent chance for cure. If you or someone you know has a rising PSA after a previous treatment for prostate cancer, educate them to the options and refer them to USMD Prostate Cancer Center. If caught early enough, time truly will be on their side.

For more information about any or all of the salvage therapies utilized for recurrent prostate cancer, please schedule a consultation by calling USMD Prostate Cancer Center at 1-888-PROSTATE (776-7828)

Dr. Bevan-Thomas, M.D.
Medical Director of USMD Prostate Cancer Center

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