Prostate cancer recurrence is every couple’s fear

When faced with prostate cancer recurrence, you may feel even more discouraged than you did when your man was first diagnosed. That’s not surprising. With initial treatment, you had high hopes for a complete cure. A rise in PSA after treatment can leave you wondering if that is still possible.

Recurrent prostate cancer is more common than you may think. Up to 70,000 men will have what is termed a PSA recurrence (which also may be called a biochemical recurrence or biochemical failure) after their initial treatment. It means that some prostate cancer cells were either left behind during surgery, or survived radiation or cryotherapy, and they are now growing either near the area where the prostate gland was (if your man had surgery), within the prostate gland (if he had radiation or cryotherapy), or they have spread to another area of the body (called metastasis).

What happens after prostate cancer recurrence has been confirmed?

The first step will probably be to determine if the cancer is localized (still in the area of the prostate gland) or has spread to other areas of the body. This may involve imaging tests (such as a CT scan and/or bone scan).

The doctor may also look at your man’s PSA doubling time (the time it takes for his PSA to double—for example, to go from 0.4 to 0.8 ng/mL), to try to determine how quickly the cancer may progress. The challenge is that there are no clear-cut guidelines for assessing a man’s PSA doubling time with recurrent prostate cancer.

What are the treatment options for recurring prostate cancer?

The treatment options for prostate cancer recurrence are as varied (and can feel as overwhelming) as they were when your man was first diagnosed. But the choice will be narrowed a bit by his initial treatment choice. Options that are presented to you for prostate cancer recurrence may include:

Salvage radiation
Salvage radical prostatectomy
Salvage cryotherapy
Hormone treatment
Chemotherapy
Watchful waiting (or active surveillance)

You may also want to read this article about prostate cancer that has metastasized and what the current treatment options are.

How is a PSA recurrence confirmed?

The definition of recurrent prostate cancer depends upon what type of initial treatment your loved one had.

If he had successful surgery for prostate cancer (such as radical prostatectomy), his PSA should immediately be undetectable.

According to American Urological Association (AUA) guidelines, a PSA recurrence after radical prostatectomy is defined as having a PSA level greater than 0.2 ng/mL and rising, which is confirmed by repeating the PSA test.

If he had successful radiation treatment (either internal or external), his PSA would still be detectable, but should remain low and stable.

According to guidelines set by the American Society for Therapeutic Radiology and Oncology (ASTRO), doctors look at what his lowest PSA value is in the months following his treatment (which is called the nadir). It may take a year or even longer to reach that lowest PSA value (the nadir) following treatment. When a man’s PSA level rises 2 ng/mL above his nadir, it is considered to be a biochemical recurrence.

While some men may receive hormone treatment as their initial treatment, it is not considered to be a curative treatment (even though the PSA level may go down).

If your man is on hormone treatment, and his PSA rises significantly from the nadir point, it may be referred to as a hormone-refractory cancer recurrence.

Try not to lose hope

Although you may fear that this is the end of the road, there may still be a chance that your loved one’s cancer can be treated successfully. It may help to know that there are currently about 90,000 men living in the United States today who have non-metastatic recurrent prostate cancer. Treatment options continue to evolve, and new research helps doctors determine what treatment—or combination of treatments—may be most effective for recurring prostate cancer. Stay current by visiting our News You Can Use section, which is updated daily.

If you haven’t previously joined a support group, now might be a good time to reach out to other wives and partners who may understand about prostate cancer recurrence. Not only can you learn from their experience, but they may also help dispel some of your fears.

To learn more about these support groups, click here.

Updated 6/09

Always discuss everything you read on this web site with a qualified medical professional.



Return from prostate cancer recurrence to homepage

Search Our Site

Custom Search