How to Know If Your Prostate Cancer Has Returned and What to Do About It.

What Is Recurrence and How Do You Know If It Has Happened?

Recurrence of prostate cancer occurs when cancer returns after initial treatment has been completed. Prostate cancer can recur locally (in the area immediately surrounding the prostate) or distantly (anywhere else in the body).

After surgery or radiation for prostate cancer that is confined to the prostate and nearby tissues, the prostate specific antigen (PSA) levels usually go down to zero or nearly zero. The PSA level should stay stable at this very low level following treatment.

The PSA level should be followed closely after initial treatment. If the PSA starts to rise again after it has gone down to zero or close to zero, this may signal that the prostate cancer has returned.

It usually takes more than one elevated PSA test to determine that prostate cancer has returned. Because many things can contribute to an elevated PSA level, most physicians want to see at least two consecutive increases in the PSA before they say that there is a good chance that prostate cancer has recurred.

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.

What Can Be Done About Prostate Cancer After It Has Recurred?

If your prostate cancer has recurred, your doctor will likely order some imaging tests to better determine where in your body the cancer has returned. Bone scans, CT scans, and MRIs are the most common tests ordered to find where in the body prostate cancer has recurred.
Many treatment options are available for prostate cancer that has returned. The one that you and your physician choose depends on individual factors such as what treatment you have already received, where in the body your prostate cancer has returned, how your cancer has spread, your general health, and your age.

If your prostate cancer is thought to have recurred in only a small area and has not spread to other areas of the body, then radiation therapy to that area may be an option.

If your prostate cancer has most likely spread to multiple areas of the body, then hormonal therapy would likely be an option. Chemotherapy is less commonly used in prostate cancer, but can also be used when the cancer has spread to multiple sites.

_Sources:
Geller J. Basis for hormonal management of advanced prostate cancer. Cancer. 1993 Feb 1;71(3 Suppl):1039-45.
Kupelian PA, Buchsbaum JC, Elshaikh M, et al. Factors affecting recurrence rates after prostatectomy or radiotherapy in localized prostate carcinoma patients with biopsy Gleason score 8 or above. Cancer. 2002 Dec 1;95(11):2302-7.
Vickers AJ, Bianco FJ Jr, Boorjian S, et al. Does a delay between diagnosis and radical prostatectomy increase the risk of disease recurrence? Cancer. 2006 Feb 1;106(3):576-80.