Prostate Cancer Recurrence

Understanding prostate cancer recurrence

The completion of prostate cancer treatment can bring both relief and worry. When caught early, initial treatment may mean you are considered free of disease. Most men diagnosed with prostate cancer will live cancer-free for years, and some even the rest of their lives. But you may also feel worried, anxious, or fearful that your cancer may come back.

Cancer recurrence is the return of cancer after a period when no cancer cells could be detected in the body. A fear of recurrence is normal and reasonable for all cancer survivors. It is important to remember that although you cannot control whether your cancer recurs, you can control how much you let the fear of recurrence affect your life.

Fortunately, the five-year survival rate for men with localized prostate cancer is nearly 100%. However, up to 40% of men will experience a recurrence, so it is important to understand your risk for recurrence.

When a man has treatment for prostate cancer, his PSA level may drop significantly. Regular PSA testing is one of the tools your treatment team will use to determine whether or not the treatment is working.

Biochemical recurrence

When PSA levels rise to a certain threshold after prostate cancer treatment, this is known as biochemical recurrence. This means that some cancer cells have survived and are producing PSA. If this happens, the doctor will order additional tests and make recommendations for how to manage your disease. Just as you did at the time of diagnosis, consider a second opinion and seeking care from a multidisciplinary team. Click here to learn more about choosing your healthcare team.

There are differing opinions in the medical community about how best to manage a biochemical recurrence from immediate treatment to delayed treatment. Many factors will need to be considered, including the characteristics of your initial cancer, the rate of your PSA doubling time, your initial treatment option, and your personal health. Talk with your healthcare team to make a plan.

What is the risk of prostate cancer recurrence?

After completing initial prostate cancer treatment, many men worry about the possibility of the cancer coming back. While advances in treatment have improved outcomes, recurrence remains a concern for some patients. Understanding the risk factors and recurrence rates can help you stay informed and proactive about your health.

Recurrence rates for prostate cancer vary depending on several factors, including:

• Initial stage and grade of the cancer
• Type of treatment received (surgery, radiation, hormone therapy)
• Gleason score and PSA levels before and after treatment
• Age and overall health of the patient

In general, men with higher-risk prostate cancer (advanced stage, high Gleason score, or high PSA levels) have a greater likelihood of experiencing a recurrence. However, it's important to note that every patient's situation is unique, and your individual risk may differ from general statistics.

To detect prostate cancer recurrence early, regular PSA monitoring is crucial. After treatment, your PSA levels should drop significantly. A rising PSA level over time may indicate a recurrence, even in the absence of symptoms. Your healthcare team will recommend a PSA monitoring schedule based on your specific case, typically involving tests every few months in the years following treatment.

Signs and symptoms of prostate cancer recurrence 

In some cases, prostate cancer recurrence may cause noticeable symptoms. However, some men may experience a "biochemical recurrence," where PSA levels rise without any apparent symptoms. Common signs and symptoms of prostate cancer recurrence may include:

1. Rising PSA levels
   • A consistent increase in PSA levels over several tests may be the first sign of recurrence
   • Your doctor will track your PSA levels and doubling time to assess the likelihood of recurrence
2. Urinary symptoms
   • Difficulty urinating or a weak urine stream
   • Increased frequency or urgency of urination
   • Pain or burning during urination
3. Bone pain
   • Persistent pain in the back, hips, or pelvis
   • Sudden onset of pain in the bones, which may indicate metastasis
4. Fatigue
   • Unexplained tiredness or weakness
   • Decreased energy levels that don't improve with rest
5. Weight loss
   • Unintentional weight loss without changes in diet or exercise habits
   • Loss of appetite or feeling full quickly

If you experience any new or concerning symptoms, it's essential to report them to your doctor promptly. While these symptoms may have other causes, it's crucial to rule out the possibility of prostate cancer recurrence.

Remember, early detection of recurrence allows for timely intervention and may expand your treatment options. Stay vigilant about your follow-up care, and don't hesitate to discuss any questions or concerns with your healthcare team.

Tips for coping

It is common to experience some fear about your cancer recurring. Accept that you are going to experience some fear and focus on finding ways to help yourself manage the anxiety or depression.

See our mental health page for more tips on coping with prostate cancer, the fear of recurrence, and finding resources that can help.