A recurrence means that the prostate cancer has not been cured by the initial treatment. Surviving prostate cancer cells have become evident again on evaluation.
Usually after surgery to remove the prostate, PSA levels in the blood decrease and eventually become almost undetectable. After radiation therapy, PSA levels usually drop to a stable and low level.
If PSA levels begin to rise at any time after treatment, a local or distant recurrence may be occurring, requiring additional testing.
Prostate cancer can recur locally in the tissue next to the prostate or in the seminal vesicles (two small sacs next to the prostate that store semen). The cancer may also affect the surrounding lymph nodes in the pelvis or lymph nodes outside this area.
Prostate cancer can also spread to tissues next to the prostate, such as the muscles that help control urination, the rectum, or the wall of the pelvis. It also can travel through the bloodstream and recur distantly in bones or other organs. This spread is called metastasis. Metastases through the lymph channels are called lymphatic metastases, while those through the bloodstream are hematogenous, or blood-borne metastases.
How Common Is Recurrence of Prostate Cancer?
According to the American Cancer Society, nearly 100% of men with low- to intermediate-grade prostate cancer ( the most common types) can expect to live at least five years after the initial diagnosis. Since many men who get prostate cancer are already elderly, they are more likely to die from causes other than the cancer.
More than 90% of the time prostate cancer is discovered while it is either confined to the prostate gland or has spread beyond the prostate only to a small degree, referred to as regional spread.
Among the less than 10% of men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis, about 30% are expected to survive at least five years.
How Is a Recurrence Detected?
After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.
When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests (such as a bone scan) may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.
Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.
What Factors Determine the Likelihood of Recurrence?
Several signs can point to a prostate cancer that has come back or spread, including:
- Lymph node involvement. Men who have cancer cells in the lymph nodes in the pelvic region may be more likely to have a recurrence.
- Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
- Gleason score. The higher the grade, the greater the chance of recurrence. Your doctor can tell you your score when the biopsy results come back from the laboratory.
- Stage. The stage of a cancer is one of the most important factors for selecting treatment options, as well as for predicting future outlook of the cancer.
What Type of Follow-Up Treatments Are Recommended?
If prostate cancer recurs, follow-up treatment depends on what treatment you have already had, the extent of your cancer, the site of recurrence, other illnesses, your age, and other aspects of your medical situation.
One possible treatment might include hormone therapy. Researchers are working on new drugs to block the effects of male hormones, which can cause prostate cancer to grow, and drugs to prevent prostate cancer growth.
Radiation therapy, ultrasound, extreme cold, electrical current, or medicines may be used to relieve symptoms of bone pain. Chemotherapy or other treatments being medically researched are also options.
Now in clinical trials are several types of vaccines for boosting the body's immune system against prostate cancer cells. Sipuleucel-T (Provenge) is the only vaccine available on the market for prostate cancer.