Prostate cancer recurrence – It’s not the end of the road

When faced with prostate cancer recurrence, you may feel more discouraged than you did when your man was first diagnosed. That’s understandable.

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.

A common problem

Recurrent prostate cancer is more common than you may think.

Up to 30% of men will have what is termed a PSA recurrence after initial treatment (which is also called biochemical recurrence or biochemical failure).

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 the cancer has spread to another area of the body (called metastasis)

How is recurrence confirmed?

The definition of recurrent prostate cancer depends upon the type of initial treatment.According to American Urological Association (AUA) guidelines, after radical prostatectomy, a PSA recurrence is defined as having a:PSA level greater than 0.2 ng/mL and risingThis is confirmed by repeating the PSA test

After internal or external radiation treatment, PSA will still be detectable.  According to guidelines set by the American Society for Therapeutic Radiology and Oncology (ASTRO):

  • Doctors look at the lowest PSA value in the months following treatment (called the nadir)
  • It may take a year or longer to reach the nadir following treatment
  • When a PSA level rises 2 ng/mL above the nadir, it is considered to be a biochemical recurrence

Some men receive hormone treatment as initial treatment, but it is not considered to be curative, even though PSA may go down.

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

After prostate cancer recurrence is confirmed

The first step will 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 PSA doubling time (for example, a rise from 0.4 to 0.8 ng/mL), to try to determine how quickly the cancer may progress.

Treatment options for recurring prostate cancer

Treatment options for prostate cancer recurrence are as varied as they are with an initial diagnosis.

The choice will be narrowed by the initial treatment choice. Options presented for prostate cancer recurrence may include:

There are also treatment options for prostate cancer that has metastasized.

Try not to lose hope

There may still be a good chance that your loved one’s cancer can be treated successfully.

Treatment options continue to evolve and new research helps doctors determine what treatment — or combination of treatments — are most effective for recurring prostate cancer.

Stay current by visiting our News You Can Use section, which is updated daily.

You don’t have to go it alone

If you have not previously joined a support group, now might be a good time to reach out to other wives and partners who are coping with prostate cancer recurrence. They may help calm your fears.

Learn more about prostate cancer support groups.

Cookson MS, Aus G, Burnett AL, et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol. 2007;177(2):540-545.

Moul JW, Banez LL, Freedland SJ. Rising PSA in nonmetastatic prostate cancer. Oncology. 2007;21(12):1436-1454.

Understanding prostate cancer recurrence. Accessed April 22, 2013.

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