If prostate cancer comes back
A recurrence means that the prostate cancer has returned after initial treatment.
Usually after surgery to remove the prostate gland, prostate specific antigen (PSA) levels in the blood decrease and eventually become almost undetectable. After radiotherapy PSA levels usually drop to a stable and low level.
If PSA levels begin to rise at any time after treatment, they may indicate a local or distant recurrence of the cancer, which calls for 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. The cancer can also recur distantly in bones or other organs. This spread is called metastasis.
How common is recurrence of prostate cancer?
Office for National Statistics data show that the five-year relative survival rate (an estimate of the probability of survival from the cancer alone) for adults in England diagnosed with prostate cancer between 2001 and 2006, and followed up to 2007, was 77%. Since many of the men who get prostate cancer are already elderly, they are more likely to die from other causes than from the cancer itself.
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 to only a small degree - referred to as regional spread.
Among the fewer than 10% of men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis, about 34% are expected to survive for 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 to detect any cancer recurrence.
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 performed, depending on your situation and symptoms.
What factors determine the likelihood of recurrence?
Several signs can point to a prostate cancer that has returned or spread including:
- Men who have cancer cells in the lymph nodes of their pelvic region may be more likely to have a recurrence.
- In general the larger the tumour, the greater the chance of recurrence.
- 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.
- The stage of a cancer is one of the most important factors in selecting treatment options as well as in predicting the future outlook for the cancer.