What does recurrence mean?
A recurrence means that the cancer has returned after initial treatment.
Usually after surgery to remove the prostate, PSA levels in the blood decrease and eventually become almost undetectable. After radiation therapy, PSA levels usually drop to a stable and low level. If the PSA levels begin to rise at any time after treatment, a local or distant recurrence may be suspected, requiring 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) and/or it may affect the surrounding lymph nodes in the pelvis or lymph nodes outside this area. Prostate cancer can also spread to adjacent tissues, such as the muscles that help control urination, the rectum, and/or the wall of the pelvis. Prostate cancer can also recur distantly to bones or other organs. This spread is called metastasis.
How common is recurrence of prostate cancer?
More than 90 percent of men with prostate cancer can expect to live at least 5 years after the initial diagnosis. According to the American Cancer Society, 67 percent of men diagnosed with prostate cancer survive at least 10 years and 52 percent survive 15 years. Since many men who get prostate cancer are already elderly, they are more likely to die from other causes than the cancer.
When prostate cancer is confined to the prostate gland, as occurs in 58 percent of all men with prostate cancer, nearly 100 percent of these men can expect to live at least 5 years with respect to their prostate cancer diagnosis.
Among the 11 percent of men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis, about 31 percent are expected to survive at least five years.
How do I know if there is a recurrence?
After prostate cancer treatment, you will return 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 detect PSA levels. This test will help the doctor detect a 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 done, depending on your situation and symptoms.
What factors determine the likelihood of recurrence?
There are several signs that help predict the chance of your cancer coming back, including:
- Lymph node involvement. Men who have lymph node involvement in the pelvic region may be more likely to have a recurrence.
- Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
- Gleason score. This scoring system is a two-part scoring system with a total score of 2 to 10. The first portion of the Gleason score measures the aggressiveness of the cancer cells. Grade 1 tumors are least aggressive and grade 5 tumors are most aggressive. The second part of the Gleason score gives a combined score based on cell type. To further explain, when the pathologist reviews tumor cells, they note a predominate cell type and a secondary cell type. A grade is assigned to each type and then added together. The higher the grade, the greater the chance of recurrence. Your doctor can tell you your score when the biopsy results come back.
- Staging. Staging refers to the original site of the cancer as well as how far it has spread within the prostate, to nearby tissues, and to other organs. Early prostate cancer (stages 1 and 2) is confined to the prostate. Late-stage prostate cancer (stage 3) has spread to areas just outside the gland. Stage 4 prostate cancer has spread to other organs or tissues further from the prostate. The stage of a cancer is one of the most important factors in selecting treatment options, as well as the most significant (but not the only) factor in predicting outlook for the future.
What type of follow-up treatments are recommended?
If prostate cancer recurs, follow-up treatment will depend on what treatment you have already had, the extent of your cancer, the site of recurrence, presence of other illnesses, your age, and other individual aspects of your medical situation.
One possible treatment is hormone therapy. New drugs to block the effects of male hormones, which can cause cancer to grow, and drugs to prevent prostate cancer growth are being developed.
Radiation therapy or medicines may be given to relieve symptoms of bone pain. Chemotherapy or other treatments being medically researched may also be considered.
Several types of vaccines for boosting the body's immune system against prostate cancer cells are being tested in clinical trials. However, at this point, none of these vaccines are available for the general public.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/15/2004…#8640
