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Post-prostatectomy cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on July 25, 2022.

While a prostatectomy is a recommended prostate cancer treatment option for many men, some will need additional treatment in the future, especially if some cancer cells remain. The risk of prostate cancer recurrence is also not entirely mitigated by a prostatectomy. Certain factors specific to each patient and each patient’s cancer are used in estimating the risk of recurrence.

After a prostatectomy, the care team will continue to monitor the patient’s health with regular prostate-specific antigen (PSA) tests. While PSA numbers are expected to be very low after surgery, they may fluctuate, which is why more tests may be needed.

If PSA levels are rising, some additional tests may be needed to learn more. These may include:

A number of second-line treatments are available to treat remaining or recurrent prostate cancer. Post-prostatectomy treatment options depend on the stage of cancer and whether it’s spread to other parts of the body, as well as the patient’s overall health and personal preferences.

Below are the most common treatment options for prostate cancer after a prostatectomy.

Localized treatment after prostatectomy

For localized prostate cancers (meaning they haven’t spread to other parts of the body), treatment options include:

Radiation therapy: After a prostatectomy, adjuvant or salvage radiation therapy for prostate cancer may be recommended, typically within four months of surgery if the tumor’s size warrants more treatment. Salvage radiation is recommended for localized cancer that returns after surgery and may be given with or without a hormone therapy called androgen deprivation therapy. Radiation therapy uses high-energy X-rays called photons to kill cancer cells, and it can be delivered in several ways from outside or inside the body.

Hormone therapy: Hormone therapy lowers the amount of male hormones (androgens) in the body, which may stop prostate cancer cells from growing. This treatment may be given after surgery if cancer cells remain or come back.

Active surveillance: If PSA levels are rising, but imaging tests don’t show new cancer growth, or if the cancer is very slow growing, active surveillance may be recommended. This approach closely monitors the patient with certain tests over time. Decisions to undergo active treatments may be considered in the future.

Risks of prostate cancer recurrence after prostatectomy are based on individual circumstances.

Post-prostatectomy treatment for metastatic cancer

If imaging tests show that the cancer has spread after surgery, it may have metastasized to the lymph nodes or bones. Treatment for metastatic cancer is designed to slow the cancer’s growth, ease discomfort and improve quality of life.

The most common treatments for metastatic prostate cancer include:

Hormone therapy: Reducing androgens in the body is designed to slow or stop the growth of cancer cells. Hormone therapy is given as an oral medication, but some patients may choose an orchiectomy, a surgical procedure that permanently lowers androgen levels. However, if the patient has hormone-refractory prostate cancer (HRPC), hormone therapy is usually not an appropriate option.

Chemotherapy: Chemotherapy may be given along with hormone therapy to kill cancer cells. Depending on the type of prostate cancer and where it’s spread, other treatments may be used to help ease symptoms, including:

Clinical trials on new cancer treatments or approaches may also be available.

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