Salvage therapy (also called rescue therapy) refers to any treatment modalities when standard treatments do not work.
You may have heard the terms “salvage therapy” or “rescue therapy” being used in the context of treatment for prostate cancers, human immunodeficiency virus (HIV), and more.
The approach to salvage therapy varies for each specific disease and is customized to the individual patient’s needs and the nature of their condition.
Various treatment modalities can be used as salvage therapy, including:
- Surgery (removing the cancer tissues or tumors)
- Chemotherapy (using drugs to kill cancer cells)
- Radiation therapy (using high-energy radio waves to kill cancer tissues)
- Biological or immunotherapy (using substances made by your own body or in a laboratory to boost your immune system to kill cancer cells)
- Clinical trials and novel or experimental drugs
- A combination of two or more modalities
Usually, salvage therapy is used for people with advanced diseases. In some cases, salvage therapy may cure the disease. Salvage therapy aims to:
- Improve your quality of life
- Prevent the symptoms from worsening
- Prevent the disease from progressing
What is salvage therapy used for?
Salvage therapy for prostate and other cancers
Salvage therapy is used in different types of cancers, including:
- Prostate cancer
- Breast cancer
- Lung cancer
- Gastric and esophagogastric cancer
- Colorectal cancer
- Acute myeloid leukemia (AML)
- Classic Hodgkin lymphoma
Prostate cancer affects more than 10% of American men, and in some cases, salvage therapy may be considered as a treatment option.
In the United States, most men with localized prostate cancer will be treated with prostatectomy or radiation therapy.
Unfortunately, prostate cancer can recur within 10 years in about 1 in 3 cases.
This is when salvage therapy is administered to treat the rest of the residual cancer or recurrent cancer.
Salvage therapy for prostate cancer will be discussed more extensively in this article.
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Salvage therapy for Human Immunodeficiency Virus (HIV)
HIV treatment has come a long way. The mainstay of treatment for HIV is antiretroviral therapy (ART), which is administered as soon as possible after your diagnosis.
This regime includes at least three different HIV medications of different drug classes.
Data has shown that a combination of antiretroviral drugs has proven effective in controlling the progression of HIV disease and prolonging survival.
Someone compliant with their ART regime can live a normal life span. However, as HIV is a complex disease, some people may develop drug-resistant strains of HIV, which render the ART ineffective.
Some people may find difficulty in complying with their regime because of other underlying issues such as poor mental health, poor social support, and so on.
As a result, the virus can evolve and become stronger until the medicine can no longer treat the disease.
About half of the patients receiving ART in the United States are harboring some drug-resistant HIV strains.
Hence, salvage therapy for HIV can help in these cases. Salvage therapy may also be required if you cannot tolerate certain medications.
In 2021, the United States Food and Drug Administration (FDA) approved Cabenuva, an injectable drug that you can take once a month or once every two months at your doctor’s office.
In 2022, the FDA approved Lenacapavir (Sunlenca), which can be injected twice a year at your doctor’s office.
Other drugs that may be used in salvage therapy for HIV include Fostemsavir (FTR) and Ibalizumab.
Another drug called islatravir seems promising in treating some drug-resistant strains of HIV. However, it is still in clinical trials.
If you are a person living with HIV (PLHIV) who has developed multidrug resistance, you can ask your doctor about salvage therapy.
Other conditions salvage therapy can treat
There is a long list of diseases that salvage therapy is used in, including but not limited to:
- Persistent MRSA infections
- H. pylori infections
- Invasive aspergillosis
When is salvage therapy used for prostate cancer?
In cases where prostate cancer recurs, salvage therapy is administered to treat the rest of the residual cancer or recurrent cancer.
After a prostatectomy, your doctor will monitor certain blood parameters, including biomarkers such as serum PSA levels.
Data has shown that patients who have a detectable or raised serum PSA level have a higher risk of getting metastatic prostate cancer.
This means the cancer has spread to other parts of the body, which is associated with negative outcomes.
Hence, your doctor will regularly monitor your PSA levels to ensure that salvage therapies are administered as early as possible whenever appropriate.
How salvage therapy works and what to expect during treatment
If prostate cancer recurs despite the initial radiation therapy, salvage prostatectomy can be done to remove the cancer.
There are a few ways in which salvage prostatectomy is done:
- Open surgery: the surgeon will make an incision between your belly button and pubic bone to remove your prostate and the surrounding lymph nodes and seminal vesicles.
- Laparoscopic (keyhole) surgery: the surgeon makes several small incisions through which they insert hollow tubes where a laparoscope and surgical instruments pass through to remove your prostate and the surrounding lymph nodes and seminal vesicles.
- Cryotherapy (sometimes known as cryoablation or cryosurgery): freezing the prostate cancer cells, hence killing them.
Side effects and risks of salvage therapy
Before any salvage therapy, you should discuss the risks and benefits of salvage therapy with your doctor.
Different forms of rescue therapy come with different side effects and risks, which differ according to your health status and disease progression.
Commonly, there is a possibility of developing short-term and long-term urinary, bowel, and sexual side effects from salvage radiation therapy and prostatectomy.
For more information on the specific side effects and risks of certain salvage therapy, you should consult your healthcare provider.
Problems with urination and bladder control
After a prostatectomy or radiation therapy, you may experience difficulty controlling your bladder or leakage of urine.
This is also known as urinary incontinence.
You may see some improvement in your incontinence by doing exercises to strengthen your pelvic floor muscles called Kegel exercises. Your doctor may also recommend medicines to help with this problem.
Problems with getting an erection and reduced sex drive
You may have problems getting an erection or erectile dysfunction. Reduced libido or reduced interest in sex can also happen after salvage therapy treatments.
Some people may even experience bowel incontinence which may result in diarrhea, leakage of feces, and pain around the anus. This can greatly affect your sex life.
Your doctor may also refer you to a specialist clinic to help with sexual dysfunction after your treatment.
While most salvage therapy treatments for prostate cancer are nerve-sparing (which means they try to spare the nerves that enable sexual functions), sometimes salvage prostatectomy may affect the nerves that enable sexual functions.
You should discuss this risk with your doctor, especially if you would like to have children in the future. You can opt to store your sperm before your surgery.
Feeling tired and weak
Most people feel weak and tired after salvage therapy. Different people experience this differently, but it is normal to feel this way.
Physiotherapy may help to regain your strength after a procedure. However, if you continue to feel tired and weak, or if it begins to worsen, you should consult your doctor.
Experiencing mood swings, depression, trouble with thinking, and memory problems
It is normal for some people to notice changes in their mood and cognition after rescue therapy.
These changes are usually subtle and can be treated for most people. You should consult your doctor if these changes are affecting you and you find yourself unable to cope with them.
Reduced bone density (osteoporosis)
Due to hormonal changes in your body, loss of bone density can happen. Your doctor can prescribe calcium and vitamin D supplements and regular exercise to reduce the risk of osteoporosis.
Tips for coping with salvage therapy treatment
It can be difficult to cope with prostate cancer or any advanced diseases requiring salvage therapy.
Here are some tips for coping with salvage therapy treatment, which you can do with the help of your healthcare provider, family members, and friends.
Talk about your feelings with a confidante or a healthcare professional
It is normal to feel an array of feelings, including upset, numb, frightened, unsure, confused, angry, tired, guilty, and sad. Everyone grieves in their own way.
These feelings come and will pass, but sometimes, you may experience these feelings all at once and feel overwhelmed.
It is important to find a healthy outlet for these emotions and feelings, including talking about them.
Ask for help from your family and friends
If you are feeling weak or tired, reach out to your loved ones for help in preparing or buying meals, driving to places, and managing certain chores.
Bring a family member or friend to sit in with you
In the initial stages, you may find it overwhelming to digest information from your healthcare providers, especially when you have just been given the sad news or diagnosis.
You can bring in a family member or friend to sit in consultation sessions with you. They can help you take notes, ask questions, or remind you about questions you may want to ask. You can also make a list of questions before you see your doctor.
Join a support group
You might find it easier to talk to someone outside your own friends and family. You can join cancer chats via online forums or talk to a counselor.
This information and social support can help you to know what to expect during and after salvage therapy.
You may find it easier to cope and make decisions if you have information and perspectives from other people with similar experiences.
Engage with your healthcare team to deal with physical problems
Salvage therapy treatments can cause physical changes to your body, including pain, hormonal changes, bladder problems, and sexual dysfunction.
If you experience difficulties in coping with these changes, your healthcare team, including your doctor, specialist nurse, and other healthcare professionals, can offer assistance.
Life after salvage therapy
Life after salvage therapy is different for everyone. It is important to continue to cope with the symptoms and side effects after salvage therapy.
Here are some things that you should do:
- Continue to see your doctor regularly. You will have follow-up visits to check your recovery and sort out any issues along the way.
- Continue to engage with your healthcare team. You can benefit from the continuation of care from your counselor, physiotherapist, and dietitian to further optimize your life after salvage therapy.
- Communicate with your loved ones and healthcare team.
FAQs
What is the difference between adjuvant and salvage radiation therapy?
Some people may find the terms “adjuvant radiation therapy” and “salvage radiation therapy” synonymous, but that is not the case.
In localized prostate cancer, prostatectomy is the most commonly recommended treatment by doctors.
If the cancer has a high risk of recurrence, the treatment regime will include adjuvant radiation therapy (administered within 4-6 months) after the surgery.
Usually, adjuvant radiation therapy is initiated after the patient’s urinary control is restored post-operation.
In summary, adjuvant radiation therapy is given as indicated as part of the standard treatment regime to treat high-risk prostate cancers. It is given before any evidence of cancer recurrence is seen, like raised serum PSA levels during the first 2-3 months after the surgery.
On the other hand, salvage radiation therapy is therapy given after the initial standard treatment has failed or when there is biochemical evidence that the cancer has recurred, like raised serum PSA levels of more than 0.2 ng/ml or a rising serum PSA level.
Some clinicians will recommend getting early salvage radiation therapy when the serum PSA levels are still low (less than 0.2 ng/ml) to increase the chances of a cure.
Do you need any other treatments during salvage therapy?
Yes. Your doctor may recommend hormone-deprivation therapy, especially if it is a more advanced form of prostate cancer.
This is also called androgen deprivation therapy, where your doctor prescribes you medicines to reduce testosterone levels. This can help to slow the growth of prostate cancer cells.
What is the success rate of salvage therapy?
According to some studies, salvage therapy carries a 5-year survival rate of 50–60%. This means that 50-60% of people can live longer than 5 years after salvage therapy.
What happens if salvage therapy does not work?
There are several options for salvage therapy. Hence, if one treatment option does not work for you, you can try the other.
It is important to consult your doctor to find a treatment, including clinical trials, that suits you.
Conclusion
Prostate cancer is one of the most common cancers to affect men. Doctors may suggest salvage therapy if the initial treatment, such as radical prostatectomy or radiation therapy, has failed.
Salvage therapy is any type of treatment given when the first line of treatment has failed. In the context of prostate cancer, it is administered when the cancer has recurred, as reflected in serum PSA levels after the initial treatment.
Your journey in treating prostate cancer using salvage therapy can be challenging. Hence, adequate social support and good communication with your healthcare providers are essential.
Some common side effects of salvage therapy for prostate cancer include problems with bladder and sexual function.
It is important to talk to your doctor about the side effects, risks, and benefits of salvage therapy.
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