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Treating Recurrent Prostate Cancer

Sometimes prostate cancer cells evade local treatment and continue to grow. This is referred to as prostate cancer recurrence. Prostate cancer can return slowly or aggressively, and your treatment will depend on your individual case. Recurring prostate cancer is usually detected by rising PSA levels during follow-up tests after surgery or radiation.

After surgery, PSA levels should drop to undetectable levels of 0.05 or less. With the prostate removed, there should no longer be a source of PSA. If it is still appearing in the blood, it is coming from prostate cancer cells in other locations. However, if PSA is present but not rising, there could be healthy prostate tissue remaining. Approximately 75 percent of men who undergo surgery never experience a recurrence of prostate cancer.

After radiation, PSA levels should drop, reaching a steady low point or nadir anywhere from a few months after treatment to 2-3 years. This is known as a PSA bounce and is normal following radiation. The lower the nadir, and the longer the time before PSA begins to rise again, the less likely it is that the disease will return.

In either situation, the options depend on the individual case.

Tests will be done to re-examine the spread (stage) of the disease. A bone scan will be done to check for cancer that has metastasized to the bones.

Some factors in the initial diagnosis suggest a greater possibility of recurrence. Higher Gleason scores (grades 8-10) and shorter PSA doubling times (less than 6 months) both indicate aggressive cancers. Larger tumors or spread to the lymph nodes are also signs of high risk.

If your PSA rises slowly and no other signs of the disease are present, your doctor may recommend deferring treatment. In one study, cancers detected by rising PSA after surgery took an average of 8 years to spread to other parts of the body.

After surgery, patients have the option of salvage radiation therapy to treat cancer cells that remain in the prostate area. Less often, surgery or additional radiation is used as a salvage treatment after radiation.

If the cancer looks likely to spread, or metastasize, to other parts of the body, your doctor may recommend hormone therapy, to deprive the cancer of testosterone that it needs to grow.

If signs of high risk for recurrence exist before initial treatment, your doctors may recommend combination or adjuvant therapy, or using a second method of treatment either before, during or after the primary treatment. For example, your doctor may recommend adding six months of hormone therapy to local radiation therapy, or adding salvage radiation therapy to surgery.