How Prostate Cancer Recurrence Is Detected
Following surgery for prostate cancer removal, the majority of patients will have regular appointments to check in and assess recovery progress with their healthcare provider or preferred oncologist. At each of these visits, your doctor will draw blood to run tests on various levels of biomarkers, hormones, and immunological markers, including PSA. You may also undergo minor physical assessments as part of your post-prostatectomy preventive maintenance care plan.
If prostate specific antigen levels are found to be rising, staying the same as pre-operative quantities, or slowing their rate of decrease in an unexpected way, your provider may suggest imaging tests or an X-ray of the prostate and pelvic area. A few other alternative options for detecting prostate cancer recurrence are available, although some are in the early stages of development or are not yet widely available, so should not be used as a default or go-to option for determining whether metastatic resurgence is a clear and present health risk.
Are you a practicing healthcare provider or oncologist who would like to learn more about alternative options for localized detection of recurrent prostate cancer?
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Significance Of Time Until Psa Recurrence After Radical Prostatectomy Without Neo
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
Objective: The aim of our study was to evaluate the impact of time until biochemical recurrence after radical prostatectomy without neo- or adjuvant treatment on clinical progression and cancer-related death in high-risk prostate cancer patients.
Materials and methods: A total of 433 men with clinically HRPCa treated between 2001 and 2017 were identified. HRPCa was defined as clinical stage T2c and/or biopsy Gleason score 8 and/or preoperative prostate specific antigen value 20 ng/ml. Exclusion criteria were neo- or adjuvant treatment and incomplete pathological or follow-up data. BCR was defined as two consecutive PSA values 0.2 ng/ml after RP. CP was identified as skeletal lesions, local or loco-regional recurrence. CRD was defined as death from PCa. All men were divided into two groups according to BCR. The chi-square and t-tests were used to compare baseline characteristics between groups. Biochemical progression free survival , clinical progression free survival , and cancer-specific survival rates were estimated using KaplanMeier analysis. Patients with detected BCR were analyzed for prediction of CP and CRD with respect to time until BCR. The impact of baseline parameters on BCR, CP, and CRD was assessed by Cox regression analysis.
Fear Of Prostate Cancer Recurrence Post
A new paper by Meissner et al. has reported important, long-term data on fear of recurrence and biochemical progression of prostate cancer among a large cohort of German patients undergoing radical prostatectomy. This appears to be the largest such study to date.
The results of this study are based on a total of 2,417 survivors from the multicenter German Familial Prostate Cancer Database all of whom had been initially treated by radical prostatectomy. These patients completed the Fear of Progression Questionnaire Short Form twice: on average at 7 years after radical prostatectomy and again at follow-up 9 years later . i.e., 16 years after their initial surgery.
It should be noted that > 10,000 patients were initially invited to participate in this study. Patients could have been diagnosed and treated for their prostate cancer from as early as 1993. More than 7,500 dropped out or were ineligible for one of a variety of reasons:
- 237 did not, in fact, have a radical prostatectomy as their primary treatment.
- 234 had died prior to distribution of the first survey in 2010.
- 3,566 did not appropriately complete that first survey in 2010.
- 2,029 more patients were lost to follow-up or were known to have died by the time of distribution of the second survey in 2019.
- 124 of those eligible for the second survey were found to have died after distribution of the second survey in 2019.
- 1,502 of those eligible did not appropriately complete the second survey in 2019.
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Ive Had A Prostatectomy Am I At Risk Of Cancer Returning
Although all forms of cancer are technically a cellular mutation that cannot necessarily be prevented or controlled, there are factors that may increase the risk of prostate cancer recurrence, even after surgery. These include, but are not limited to, the following:
- Stage of Prostate Cancer
- If the prostate cancer was detected in a later stage, or if cancerous tissue or tumor growth is significantly progressed, a prostatectomy may be slightly less effective for the purposes of controlling future susceptibility to recurrence.
Who Is More Likely To Have Prostate Cancer Recurrence
In general, the further your cancer has spread and the more aggressive it is, the more likely it is to recur. Specific factors include:
- Tumor size: In general, the larger the tumor, the more likely it is to recur.
- Gleason score: A higher Gleason score means a more aggressive cancer and a higher rate of recurrence.
- Cancer staging: Staging refers to how far the cancer has spread. Higher stage cancers have spread further at initial treatment and have higher rates of recurrence.
- Involvement of the lymph nodes: Prostate cancer that has entered the lymph nodes prior to treatment is more likely to recur.
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Are Other Tests Needed
A doctor will not generally recommend further treatment after a single PSA test result. They will typically monitor a persons PSA levels over time to see whether they are rising.
PSA testing is only one way to check a persons health after having a prostatectomy. A doctor may use an imaging test to look for a tumor or a growing number of cancer cells.
They are also likely to ask the individual about any possible symptoms that could suggest that prostate cancer has returned.
How To Lower The Risk Of Prostatecancerrecurrence
Lifestyle changes can help reduce your risk of prostate cancer recurrence. They range from engaging in regular physical exercise to taking nutritional supplements.
However, further research studies are needed to confirm the actions of many preventative strategies for prostate cancer recurrence. We discuss some of these approaches below.
- Undertake regular physical activity. Research suggests that regular exercise after treatment significantly reduces the risk of prostate cancer mortality compared to control groups who do not exercise.
- Maintain a healthy weight. Men who are overweight or obese at diagnosis tend to have worse treatment outcomes than those at a healthy weight.
- Quit smoking. Smoking increases the rate of prostate cancer recurrence and mortality.
- Nutrition and supplements. A healthy diet rich in vegetables and low in animal fat promotes overall health. The benefits of a healthy diet go beyond the prostate and other cancers. Some dietary supplements may help reduce the risk of prostate cancer recurrence, but further research is needed.
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Prognosis And Survival For Prostate Cancer
If you have prostate cancer, you may have questions about yourprognosis. A prognosis is thedoctor’s best estimate of how cancer will affect someone and how it willrespond to treatment. Prognosis and survival depend on many factors. Only adoctor familiar with your medical history, the type and stage and otherfeatures of the cancer, the treatments chosen and the response to treatment canput all of this information together with survival statistics to arrive at aprognosis.
A prognostic factoris an aspect of the cancer or a characteristic of the person that the doctorwill consider when making a prognosis. A predictive factor influences how acancer will respond to a certain treatment. Prognostic and predictive factorsare often discussed together. They both play a part in deciding on a treatmentplan and a prognosis.
The following are prognostic and predictive factors for prostatecancer.
Additional Treatment After Surgery
Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.
Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:
- Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
- Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
- Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.
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An Increased Psa Level
A biochemical relapse is when your PSA level rises after having treatment that aims to cure your cancer.
You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA rises quickly or stabilises. You might have a scan if your PSA rises quickly.
The choice about whether to have treatment and what treatment to have will depend on:
- the treatment you have already had
- your general health
Recurrence Of Prostate Cancer How To Prevent It
The key secret is inside the prostate cancer treatment options. So, if a radiation therapy is the therapy of choice, it is preferably combined with androgen ablation therapy .
The second choice is Flutamide as an anti-androgen. In additon to this, some uroglogists suggest for castration in order to block the influence of androgen.
On the other hand, the clinicians follow a reasonable guide-line. In case of medical castration, Gonadotrophic Releasing Hormone analogue is used. This hormone centrally down-regulates the secretion of testosterone and gradually blocks the secretion completely.
To the surgical measure, orchiectomy is the choice. There are some withdrawal effects seen in case of prolonged androgen withdrawal. Sometime, Ketoconazole and Hydrocortisone are used to suppress them.
Keep in mind that everything regarding prostate cancer recurrence depend on the personal clinical experience of the clinicians. In case of younger patiens, the principal choice is Surgical Intervention followed by Medication.
Similarly, in aged patients, where life expectancy is normally less, watchful waiting is the most preferred.
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Active Surveillance And Watchful Waiting
If your cancer is not causing any symptoms, is slow growing or is small and confined to the prostate, your doctor may suggest active surveillance or watchful waiting.
- Active surveillance means your doctor closely monitors your cancer using prostate-specific antigen tests, digital rectal exams, ultrasounds and biopsies. If a change indicates your cancer is becoming more aggressive, your doctor will talk with you about treatment options.
- Watchful waiting involves less testing. You and your doctor monitor any changes in your symptoms to determine if you need treatment.
Prostate cancer can take 10 or more years to spread enough to become life threatening, so if you already have a life expectancy of less than 10 years, it might not make sense to undergo aggressive cancer treatment, and your doctor might suggest active surveillance or watchful waiting.
These methods might also be appropriate if:
- You have a low-grade cancer and wish to defer treatment and potential side effects until treatment is necessary.
- You prefer not to undergo aggressive treatment.
- You want to avoid side effects of aggressive treatment.
- You have health problems that prevent you from being a candidate for other types of treatment.
After Surgery To Remove The Prostate
Following a prostatectomy, the course of treatment generally follows a similar path for all patients, with variations and adjustments made as needed based on test results, physical response, and overall progression of recovery, from both a provider and patient perspective. Almost universally among post-operative men who have had a cancerous prostate removed, levels of PSA are expected to drop, and this decrease is seen in a measurable way that follows suit.
However, prostate cancer is not limited to the borders of the gland itself, and it is commonly found to metastasize in the tissues directly surrounding the prostate, or in the nearby seminal vesicles . If cancer spreads after a prostatectomy, it is likely going to be found in one or both of these areas. It can also cause the affected individual to exhibit elevated levels of PSA, which, as youll recall, should be steadily dropping or fully depleted after surgery has been completed.
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How Common Is Recurrence
The recurrence of prostate cancer depends on when it was caught and treated the first time. If your doctor was able to remove the cancer while it was still confined in the prostate gland, your chances of recurrence are fairly low. If your cancer spread before treatment, such as in the case of about 10% of men, recurrence is more likely to occur. Recurrence, therefore, occurs if not all of the cancer cells were treated the first time or if the cancer was more advanced than originally believed.
What We Dont Know
While research is promising, thereâs still a lot scientists need to learn. Some things to consider:
- Thereâs no proof that ejaculating more actually causes lower chances of prostate cancer. For now, doctors just know theyâre connected. It may be that men who do it more tend to have other healthy habits that are lowering their odds.
- Ejaculation doesnât seem to protect against the most deadly or advanced types of prostate cancer. Experts donât know why.
- Scientists donât know if ejaculation during sex vs. masturbation has the same benefits. Some research has found that the makeup of semen is different for each. For example, semen during sex has higher levels of sperm and some chemicals. Itâs possible that these could make a difference in a manâs odds of having prostate cancer.
- Not all studies have found a benefit. The 2016 study got attention because of its size and length . But some smaller studies have not shown the same good results. A few even found that some men, specifically younger men, who masturbated more had slightly higher chances of prostate cancer. Some researchers wonder if a manâs age may affect whether more ejaculation helps.
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Understanding The Recurrent Prostate Cancer
Recurrent prostate cancer is when prostate cancer returns after the initial treatment or partial to complete remission has occurred. This is due to the reemergence of surviving prostate cancer cells that have grown large enough to be detected.
Following a prostatectomy, your prostate-specific antigen levels being to decrease. Eventually, they are no longer detectible, which is an indication that prostate cancer is no longer present. However, there is no clear reference for a normal PSA. It differs between men and can be affected by a number of factors. Following your initial prostate cancer treatment, PSA levels should stabilize and be low enough to where theyre not detected on blood tests. In some cases, PSA levels begin to rise again, indicating a need for further tests.
Even if youve had a prostatectomy, prostate cancer can recur in the immediately surrounding tissue, lymph nodes, seminal vesicles, muscles that control urination, the rectum, the wall of the pelvic, or metastasize into lymph nodes and bones further away.
What Is Prostate Cancer Recurrence
Prostate cancer recurrence is the return of cancer after treatment and a period when no cancer activity could be detected. Local therapies with radical prostatectomy or radiation therapy are the two main ways to eliminate localized prostate cancer.
Both options are definitive treatments because they can cure prostate cancer altogether. However, local treatments are ineffective if cancer has spread outside the prostate gland. Here, other types of treatment are needed to target cancer cells located in other parts of the body.
Cancer cells remain after curative treatments because of positive surgical margins or metastasis if the disease is more advanced than initially thought. Prostate cancer cells can start to grow again from these sites.
Treatment relapse increases the possibility of developing advanced incurable disease that needs complex treatment decisions to manage. However, current clinical methods for treating recurred prostate cancer can result in both over-treatment and under-treatment due to a lack of adequate biomarkers to predict response.
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Factors That Increase Risk Of Recurrence
There are many different factors that can help you determine what your risk of recurrence is. Your doctor will go over these during the initial course of treatment, therefore stressing the importance of follow up appointments.
One factor is the involvement of your lymph nodes. If your cancer has metastasized to your lymph nodes, recurrence is more likely. Similarly, the larger the tumor, the more likely that you are to experience complications and rates of recurrence. If the tumor is intertwined or growing into other areas of your body, this also increases risk. The Gleason score is a system of grading your prostate cancer based on severity and localization. The higher the grade, the more likely youll experience recurrence. Finally, the stage of prostate cancer affects recurrence rates. When caught early, recurrence is not as likely as cancers that are in stage three or four.
Cancer can be extremely aggressive and will change your life forever. Make sure that youre doing everything you can to avoid potential problems. Eat well, exercise regularly, and get enough sleep. Strengthening your immune system is a great way to reduce your risk of recurrence.