What If Prostate Cancer Comes Back

What Are My Treatment Options

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Recurrent prostate cancer treatment is called second-line or salvage therapy. Treatments aim to do one of two things: get rid of your cancer or slow it down .

Curative treatments include:

Radiation therapy. It uses high-energy X-ray beams to kill cancer cells. The radiation can come from a machine outside your body, which is called external beam radiation. Or you can get radiation through tiny seeds or a tube placed into your prostate, which is called brachytherapy.
Cryotherapy. This treatment uses extreme cold to kill cancer cells.
Surgery. Radical prostatectomy removes your prostate and some of the tissue around it.

Control treatments include:

Hormone therapy. It lowers the amount of the hormone testosterone in your body, or blocks it from getting to your cancer cells. Testosterone fuels the growth of prostate cancer.
Chemotherapy. This treatment uses strong medicines to kill cancer cells.

How Do I Know That My Cancer Has Come Back

Recurrent prostate cancer usually doesn’t cause symptoms unless it has spread to other parts of your body. Then you might have:

Trouble urinating

Often, the first sign that your cancer has returned is rising levels of prostate specific antigen, or PSA, in a blood test. Regular PSA testing is one way your doctor monitors you for a recurrence.

This test can’t show for sure that your cancer is back. Your doctor can do a biopsy to confirm that your cancer has returned, or a CT or MRI scan to see if it has spread.

Doctors also have an imaging test called positron emission tomography, or a PET scan, that may be better than other scans. It uses a radioactive tracer to find out where the cancer has spread and predict which treatment might work best against it.

How Does My Doctor Choose A Treatment

Once you know that your cancer has returned, you and your doctor will choose a treatment. A few factors go into making the decision, including:

Which type of treatment you had before
How aggressive your cancer is
Whether, and where, it has spread
How much time has passed since your first treatment
How quickly your PSA level is rising
Your overall health

Treatment Of Rising Psa

If PSA levels are rising slowly or by a small amount, a person may not need treatment. A doctor usually considers an individuals overall health, medical history, and age when giving advice on treatment.

Doctors often use active surveillance if PSA levels are rising. Active surveillance is a series of regular tests and health checks, with treatment only if necessary. Prostate cancer often progresses very slowly, so it may be many years before a person needs treatment.

If a person has had a prostatectomy, a doctor may also recommend radiation therapy, which kills cancer cells using high-energy particles.

Radiation therapy is not suitable for everyone who has had a prostatectomy. If a person had radiation therapy before surgery, they cannot usually have this treatment again. Having radiation therapy a second time can cause side effects.

Doctors may also use hormone therapy to shrink a persons tumors. This can make other treatments such as radiation therapy more effective.

It is not always possible to prevent PSA levels from rising. The best way to safeguard health after having a prostatectomy is by undergoing regular medical checks.

stopping smoking or using tobacco products
exercising regularly
eating a healthful diet, with plenty of fruits and vegetables
limiting alcohol intake to a moderate amount

Prostate Cancer Recurrence Isnt Limited To The Prostate

Prostate Cancer: Signs, Symptoms, and Complications

It is important to understand exactly where the recurrent prostate cancer is located in your body so that you and your doctor can choose the most appropriate treatment plan for you.

There are limitations with each of the current imaging tests used to locate recurrent prostate cancer.

While routine imaging tests including bone scans, CT scans, and MRIs can help provide some information about recurrent prostate cancer, these tests have limitations. There are newer advanced imaging tests available today. Talk to your doctor about which imaging tests are right for you.

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Following Up After Surgery

Because surgery for benign prostatic hyperplasia leaves behind most of the prostate gland, it is still possible for prostate problemsincluding prostate cancer or benign prostatic hyperplasiato develop or return.

After your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor.

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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

What Are The Side Effects Of Hormone Therapy For Prostate Cancer

Testosterone is the primary male hormone and plays an important role in establishing and maintaining the male sex characteristics, such as body hair, muscle mass, sexual desire, and erectile function. Most men who are on hormone therapy experience at least some effects related to the loss of testosterone, but the degree to which you will be affected by any one drug regimen is impossible to predict. Side effects from testosterone-lowering therapies include hot flashes, breast enlargement or tenderness, loss of bone mineral density , weight gain , higher cholesterol, and a higher risk of diabetes and heart attack. Some men experience fatigue, memory loss, and/or depression. Dont be afraid to discuss these issues with your doctors. Maintaining a healthy lifestyle through good nutrition and exercise can help reduce the impact of these side effects.

What Should My Psa Level Be After Treatment

What are the Symptoms of Prostate Cancer?

Following surgery , your PSA number should be undetectable after about a month. This is effectively zero PSA, but may not get all the way to zero, given the sensitivity of the test and the fact that other proteins may be misread as PSA proteins. The most widely accepted definition of a prostate cancer recurrence after surgery is a PSA of 0.2 ng/mL or greater on at least two separate occasions.

If youve had radiation therapy, your PSA will likely not drop to zero, as there is some normal, healthy prostate tissue that remains after treatment. Instead, there is a different low PSA level for each patient, called a nadir. The most widely accepted definition is a PSA that has risen from nadir by 2 ng/mL or more. Either way, its important to always use the same lab, if possible, for all of your PSA tests because PSA values can fluctuate somewhat from lab to lab. Defining failure after other forms of therapy like brachytherapy seeds or cryotherapy is more challenging, but similar to that used with external radiation.

If your PSA is rising but doesnt quite meet these definitions, your doctor may recommend an evaluation to see whether your prostate cancer has recurred.

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Do I Need Treatment Right Away

Not necessarily. If your PSA level hasn’t risen much and you’re not at high risk of the cancer spreading, “active surveillanceÃ¢â¬ï¿½ could be an option.

Active surveillance means your doctor will monitor your cancer with regular PSA tests. If it starts to grow or cause symptoms, then you’ll start on a treatment.

Prostate cancer often grows very slowly and never becomes life-threatening. Active surveillance lets you delay treatment and avoid side effects, sometimes for many years. Another reason to wait is if you’re still recovering from side effects of your first treatment.

Not everyone is comfortable with the idea of putting treatment on pause. It’s a personal decision that you should make only after carefully weighing the pros and cons with your doctor.

Treatments For Recurrent Prostate Cancer

Recurrent prostate cancer is cancer that comes back after it has been treated. Recurrent prostate cancer is also diagnosed when theprostate-specific antigen level starts to rise quickly after initialtreatment but there are no other signs of cancer. This is called a biochemicalrecurrence or PSA failure.

The following aretreatment options for recurrent prostatecancer. Your healthcare teamwill suggest treatments based on your needs and work with you to develop atreatment plan. The type of treatment that you receive will depend on:

the treatments youve already had
where the cancer comes back
whether the cancer has spread
your overall healthand whether you have other illnesses
your age and life expectancy
your personal preferences

What To Ask When Your Psa Is Rising After Initial Treatment

Advanced Prostate Cancer

For the majority of men, prostate cancer is treatable and curable and does not come back after initial treatment. However, about 25%33% of men with prostate cancer will experience a recurrence of their cancer after surgery or radiation. Some of these men can still be cured with additional treatment, but some men develop a form of prostate cancer that, while not curable, remains TREATABLE for a very long time.

Below is a list of questions to ask when your PSA is rising after initial treatment.

My Takeaways From This Article

Is HIFU an Option if the Cancer Comes Back?

Im not a doctor or a medical services provider, just an eleven-year prostate cancer survivor, so the following comments are just my opinion and should be considered as such.

I read in the article that between 15-40% of men who undergo a radical prostatectomy for localized prostate cancer will experience a recurrence of the disease. This reinforces for me the absolute criticality of detecting prostate cancer at the earliest possible stage. That means beginning an annual prostate cancer screening program at age 35 and personally tracking any changes from one year to the next.

Secondly, its just as critical to know if you have an aggressive form of prostate cancer. Your pathologist will play a critical role here, because the pathologist dissects the prostate tissue following surgery and gives the prostate cancer a Gleason grade, showing how advanced it is.

This article suggests that men diagnosed with aggressive prostate cancer should go through a course of radiation treatment. I cant comment medically on that suggestion, but this seems to me to be a logical course of action. I was not given localized radiation therapy following my surgery nor was it even mentioned. At 13 years since surgery my PSA remains at .04 .06, so perhaps Im in the non-recurrence bucket but maybe not. One never knows. I wish I had been advised about other additional treatment options following my surgery.

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Dizziness When You Change Position

You might feel dizzy if you sit or stand up suddenly. This is more common if you are 65 or older, but it can happen at any age. If you already feel dizzy from cancer or its treatment, changing positions quickly can make the dizziness worse.You can be at risk of falling if you are dizzy at any age. But older adults are more likely to have a serious injury if they fall.

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Treatments Aiming To Get Rid Of The Cancer

External beam radiotherapy uses high-energy X-ray beams to destroy cancer cells. You might have it with or without hormone therapy.
Permanent seed brachytherapy involves implanting tiny radioactive seeds into your prostate.
High dose-rate brachytherapy involves inserting thin tubes into the prostate. A source of radiation is passed down the tubes into the prostate for a few minutes. The tubes are then taken out.
Surgery removes your prostate and the cancer inside it.
One of the treatment is HIFU
In order to destroy the cancer cells the doctor will recommend cryotherapy.

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In The Absence Of Any Other Symptoms Such As Bone Pain What If Anything Should Be Done If Biochemical Relapse Is Detected

If the PSA is still low, less than 2 or 3 ng/ml, many people opt to do nothing.

PSA is very sensitive in detecting any recurrence of cancer. Thats because only prostate cells make PSA, so if it goes up after a radical prostatectomy, it means prostate cells are still present somewhere. This thing means that a small number of cells have been missed before they were eliminated, and this time they incresed so much theyre producing enough PSA to be discovered.

This interval between the reappearance of PSA and the first sign of advanced disease can be predicted, the Johns Hopkins researchers found, using three pieces of information:

The Gleason score of the pathologic specimen . Is it Gleason 7 or lower or Gleason 8 or greater?
When PSSA comes back?Is it less than two years aftersurgery or more?
How long does it take for the PSA level to double? Greater or less thanten months?

If a man has Gleason 7 disease, has his first PSA recurrence more than two years after surgery, and has a PSA doubling time longer than ten months, his likelihood of being free of metastasis at seven years is 82 percent.

Conversely, if a man has Gleason 7 disease, but his PSA goes up within two years of surgery and the time it takes PSA to double is less than ten months, his likelihood of being metastasis-free at seven years is 15 percent.

What Does Rising Psa Mean

Remission and Cure After Relapse Prostate Cancer | Mark Scholz, MD | PCRI

When the PSA is rising or cancer spreading despite a low level of testosterone, prostate cancer is called castration-resistant, or hormone-refractory. Despite this name, some hormonal therapies may still work. But prostate cancer in this setting will inevitably progress and become more aggressive and resistant, and you should be prepared to discuss more aggressive treatment strategies with your doctor. This is the time when a medical oncologist, if not already involved in your care, gets involved. These doctors specialize in systemic treatments for prostate cancer, which is useful at this time given that your disease is typically systemic, meaning that it is not confined to only one location. Cancer cells in this situation have typically spread through the blood stream or lymphatics to other places in the body, and localized treatments are rarely helpful except in circumstances where urination becomes difficult. You should talk to your doctor about these systemic therapies, when to start chemotherapy, and clinical trials that may be available.

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Cancer Treatments Linked To Dizziness

Some types of chemotherapy may cause dizziness. Drug-related dizziness may go away after you have taken the drug for a few days or weeks. Tell your health care team about the dizziness and any other symptoms you have during chemotherapy. Today, many medications are available to treat the side effects from chemotherapy.

Radiation therapy to the brain, spine, or other parts of the body related to the nervous system can also cause dizziness.

How To Handle A Relapse After Treatment For Prostate Cancer

Am I going to die? This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen level has risen after he has already undergone treatment for prostate cancer . The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.

Thats usually of small comfort to the patient whose PSA has risen. Its emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, its as if theyre dealing with another diagnosis of cancer, except this time its much worse because there is less likelihood of getting cured. A mans confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.

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Caring For Your Incision

The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.

How Do I Know If Treatment Worked

Most commonly, doctors monitor prostate-specific antigen levels in your blood. If treatment has worked, there will often be lower levels of PSA in your blood. Higher PSA levels might be a sign of cancer, though PSA levels can fluctuate without a cancer diagnosis.3

PSA levels typically drop to lower levels and become stable after radiation therapy for prostate cancer. PSA levels will also become virtually undetectable when you have surgery to remove your prostate. Your doctor will use PSA levels in combination of other tests to see if your treatment has worked.3

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