Prostate cancer that is no longer confined to the prostate gland needs to be treated with systemic treatments that affect your entire body, not just the targeted or localized area that primary treatment is designed to accomplish.
Exceptions would be:
* You still have your prostate gland after non-surgical primary treatment such as radiation or received seeds (Brachytherapy), cryosurgery or HIFU (High Intensity Focused Ultrasound), and the subsequent PSA rise is due only to lingering cancer cells that remain active in your prostate gland. Here additional focused treatment to the gland itself may help.
* Or, you may have some prostate cancer cells remaining in the area close to where the gland had been prior to surgery. It is possible to treat these “hot spots” with external beam radiation and halt the cancer’s progress.
I no longer think of my prostate cancer as curable, but as chronic…something I can fight until I am in my nineties and maybe, even, my hundreds
Treating Reoccurring Prostate Cancer
Reoccurring prostate cancer, when caught early after primary treatment, is sometimes treatable with another locally focused procedure, such as radiation or cryotherapy, but it must be caught very early in its progression, in cases of failed surgery prior to the PSA making it to 1.0. This second, locally focused treatment is often called “salvage therapy.”
After your treatment, always remain vigilant in monitoring your PSA so you could catch a reoccurrence very early.
If the primary treatment you had was surgery, and your PSA begins to rise, or if the PSA fails to become undetectable following surgery, beginning radiation salvage therapy and hormone therapy may still beat the cancer and provide you with a good outlook. If the primary treatment was radiation, surgery or focal surgery may beat the cancer.
If you find yourself in this position, it is best to identify where the cancer is located in order to develop an optimum treatment plan. Scans are the best way to accomplish this. In addition to glucose-based PET scans, one other FDA-approved method, a PET scan using c11 Choline PE, is available only at the Mayo Clinic in Rochester, Minnesota. Unlike glucose, Choline is rapidly taken up by prostate cells so Choline-based scans will indicate a significant metabolic uptake in areas where the cancer has spread. Unfortunately, these scans also have a high rate of false positives, so confirmatory tests should be performed. (To learn more about Choline-based PET scans go to the advanced prostate cancer blog at:
If the scan identifies four or fewer lesions, the disease might actually be considered oligometastatic (meaning “isolated distant metastases”) and may still be treatable with “curative intent” (Citations at www.ncbi.nlm.nih.gov/pubmed/23151910 and http://jnumedmtg.snmjournals.org/cgi/content/meeting_abstract/52/1_MeetingAbstracts/35.)
For details, and to request an appointment at the Mayo Clinic for a Choline C-11 PET scan in conjunction with evaluation for Reoccurring prostate cancer, call 507-284-5052 from 8 a.m. to 5 p.m. Central time, Monday through Friday.
In addition to the FDA-approved choline-based PET scan, there are other as yet unapproved contrast agents being used to identify prostate cancer outside of the gland (in the prostate bed). The best known is USPIO nanoparticles with Feraheme (ferumoxytol) that is used only at the Sand Lake Imaging Center in Orlando, Florida (9350 Turkey Lake Rd, Orlando, FL 32819, 407-363-2772).
This procedure uses ultra-small super-paramagnetic iron oxide (USPIO)-enhanced MRI/CT fusion study of chest, abdomen and pelvis. The scan examines lymph nodes as well as other soft tissue sites and organs for any abnormality. The procedure requires a slow infusion of USPIO nanoparticles with Feraheme (ferumoxytol) on day one and then a CT scan of the abdomen and pelvis day two.
Ferumoxtran-10 (aka Combidex MRI in the United States and Sinerem MRI in Europe) is another alternative scan contrast. Currently it is only available at Radbound University in Holland. In 2004 the FDA did not approve it, stating that there were insufficient clinical data to support a broad indication for use of ferumoxtran-10 to differentiate metastatic from non-metastatic lymph nodes across all cancer types.
Ferumoxtran is highly sensitive, being able to discriminate lymph nodes down to 2mm (as opposed to C11 that discriminates down to 4mm and a PET Scan that discriminates down to 10mm). A Combidex MRI is done over a two day period: day one involves having an infusion of the contrast and day two having the actual MRI procedure.
If you missed catching a post-surgical recurrence prior to a PSA score rising above 1.0, or if your cancer is not oligometastatic, there are still many available treatments that will slow the progress of the cancer, reduce symptoms, and extend your life for many years. Always remember: the treatment goal is to turn Reoccurring prostate cancer into a chronic, long-term illness, while still maintaining a great quality of life.