May 01, 2016

Prostate cancer recurrence

Knowing when to act

Prostate cancer recurrence

A year ago, you were quietly celebrating the success of your treatment for prostate cancer. Now, blood tests show that the level of a substance produced by prostate tissue that can also indicate cancer growth — prostate-specific antigen (PSA) — is on the rise.

About 30 percent of men who have an initial prostate cancer removed with surgery (radical prostatectomy) will have a rise in PSA levels at some time. But of that 30 percent, only about a third will end up with a cancer recurrence.

In men who received radiation as the only treatment for prostate cancers, PSA is a more variable measurement that can be difficult to interpret. The number of these men who have cancer recurrence after radiation varies depending on the radiation treatment regimen, but the number can be higher than would occur after initial radical prostatectomy.

Is it back?

Changing PSA numbers after initial prostate cancer treatment warrants careful monitoring. But at what point does PSA information along with other indicators signal the need for additional treatment? That's not always clear, but new technology and refined thinking are helping men and their doctors make informed decisions.

If you've been treated for prostate cancer, the role of PSA testing takes on added importance. Since prostate cancer cells usually produce PSA, declines in PSA levels can gauge the effectiveness of treatment — and rising PSA levels can indicate a return of prostate tissue growth, which may be cancerous.

For men who have had a cancerous prostate removed with radical prostatectomy, PSA levels should fall to essentially undetectable levels. Any rise in PSA is...