If the disease has already spread or if the doctor suspects that it may have spread, the patient is typically given androgen-suppression therapy. Chemotherapy drugs in combination with hormonal drugs are being investigated for patients who fail surgery or radiation.
A 2005 study in the Journal of the American Medical Association suggested three factors that may help doctors and patients decide if additional treatment is needed if cancer recurs after surgery:
- How quickly PSA levels double after surgery (shorter time equals higher risk)
- How quickly the cancer recurred after surgery (shorter time equals higher risk)
- Gleason score (higher score suggests more aggressive tumors and greater risk)
Patients at high risk are more likely to die from the recurrent cancer and should be considered for additional treatments. Patients at low risk face a lower likelihood of death from prostate cancer and probably do not require more treatment. The study found that for patients at low risk, the time to death after cancer recurrence was very long, generally lasting more than 16 years
Androgen-Suppression Therapy. Treatments that block or suppress androgens (male hormones) are often the appropriate response to rising PSA levels after treatment failure. There has been some debate over whether to start this therapy as soon as PSA levels rise or wait until symptoms develop. Some studies indicate there is no increased survival from early treatment, and patients have a better quality of life if therapy is started only after symptoms have occurred. A major analysis in 2002, however, reported that early intervention prolonged survival over a 10-year period.
Salvage Prostatectomy. Salvage prostatectomy is sometimes performed after unsuccessful radiation treatment if the cancer is still local. The odds of the procedure's success are only 10 - 64%. Many experts recommend against salvage prostatectomy in most cases of radiation failure. Severe complication rates for salvage prostatectomy are very high: 10 times that of men who have not had radiation. For example, incontinence after salvage prostatectomy is often untreatable with medications, collagen implants, or other standard treatment measures.
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