Increasingly, we have become better informed about the possible role of psychological and spiritual interventions in the treatment of cancer, specifically for this post in men with locally advanced prostate cancer. This post is limited to just discussing the possible interventions specifically in men with a Biochemical Prostate Cancer Recurrence, commonly referred to as a PSA only recurrence.
Men who have this type of recurrence are asymptomatic, or they have no symptoms. Their only indication of a prostate cancer recurrence is a rising PSA. Despite the current research (CaPSURE https://urology.ucsf.edu/research/cancer/capsure), showing that early intervention does not extend survival, most men want to quickly move on to treatment with either targeted radiation or hormone therapy.
Why is there such a great push to start treatment, anxiety is the usual driving force for decisions to begin quick treatment protocols. It doesn’t matter that there is no evidence that quick treatment will extend life, as a matter of fact the evidence is that early intervention will not extend life. Treatment, including early treatment, will create side effects, but it will not extend life.
Perhaps, the best treatment for a man at this juncture isn’t radiation or hormone therapy, but it is a psychological type of intervention that will reduce anxiety so that a man doesn’t become overwhelmed.
Does this sound familiar? The very same issues play a part in men who are more appropriately treated using active surveillance upon initial diagnosis of prostate cancer instead of another primary treatment.
Yet, rarely are psychological interventions discussed for men in these situations! Why is this the case? What can we do to help men on Active Surveillance and who have a Biochemical Prostate Cancer Recurrence? Psychological interventions designed to reduce anxiety would be a greta and important step forward.
Hi Joel,
I cannot agree with your assertion that current research shows early intervention does not extend survival. I assume you are referring to the retrospective CAPSURE analysis by Hsu et al. I think it shows just the opposite. They found that waiting until after PSA reached 1.0 ng/ml significantly increased the risk of metastases and prostate cancer mortality. In fact, they found that men who waited for salvage radiation had a prostate cancer mortality rate 4 times higher than men who had adjuvant radiation. I discussed that study more fully in an article titled “Does Early Salvage Radiation Save Lives?” http://prostatecancerinfolink.net/2015/01/26/does-early-salvage-radiation-save-lives/
The natural history of prostate cancer progression is very slow compared to other cancers. Therefore, it takes a long time of tracking, maybe 15 or more years, before the survival benefit becomes evident. During the early period, we may have an opportunity to intervene that may be lost later if the cancer becomes systemic. For men with life expectancy of less than 10 years, treatment may be unnecessary, but for younger, healthier men, early intervention may save lives. Still, many men may have detectable PSA and face little risk of progression. So how do we distinguish those who won’t need treatment from those who will benefit from early salvage? Some useful indicators are PSA kinetics (rising rapidly), uPSA>0.03 (in the setting of adverse pathology), and the Decipher genomic classifier. Eventually, we will have the results of randomized clinical trials that will provide more reliable info.
For me, nothing quells anxiety like information.