What Happens If Prostate Cancer Comes Back?

February 22,2021 |
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The prostate is a small gland about the size of a walnut that helps make seminal fluid. It’s intertwined with your urinary tract system, resting below your bladder and surrounding the urethra. As you age, this gland continues to grow, sometimes resulting in benign prostatic hyperplasia. While this growth is normal, cancerous growth is not. Cancer occurs when the cells in your prostate gland begin to grow out of control.

While prostate cancer is common, especially among older men, it’s got a fairly positive outcome. When caught early and treated, most men survive and continue on with remission after five years. Unfortunately, for a small percentage of men, the cancer returns. To give you some clarity on this situation, here’s what happens if prostate cancer comes back.

Understanding Prostate Cancer

As mentioned, prostate cancer is when the cells in the prostate gland begin to mutate and grow rapidly. While there are many factors that can increase your risk of developing cancer, everyone is susceptible to DNA mutations throughout their lifetime. Certain gene mutations are inherited while others are acquired, so the best thing you can do is to live a healthy lifestyle and make sure that you’re getting regular prostate exams after the age of 50—younger if you’re high risk.

There are a few different types of prostate cancer but the most common is adenocarcinomas. This is when the cancer develops from the gland cells and slowly grows or moves. There are also a few pre-cancerous conditions that you should be aware of, such as prostatic intraepithelial neoplasia (PIN) and proliferative inflammatory atrophy (PIA). If you think you may have PIN or PIA, or have a history of prostate cancer, talk to your doctor about what you can do to increase screenings and reduce your risk factors.

It’s important to talk to your urologist at the first sign of any symptoms of prostate cancer. The most common symptoms include:

  • Trouble urinating
  • Decreased force in stream of the urine
  • Blood in the urine
  • Blood in the semen
  • Bone pain
  • Losing weight without trying
  • Erectile dysfunction

Since many of these are also common urologic conditions, getting the proper diagnosis is essential.

Prostate Cancer Treatment

If you’ve been diagnosed with prostate cancer, try to remain calm. As we mentioned, prostate cancer is one of the most curable cancers there is. When caught early, it has close to a 99% cure rate and most men make a full recovery. Your treatment will be determined based on the stage and grade of your cancer, your age, any underlying conditions, and your general feelings on how you’d like to proceed.

The most common treatment option is to surgically remove the prostate through a radical prostatectomy. This is especially effective when the cancer is localized. It can be done laparoscopically or during open surgery depending on your circumstances.

Other treatment options include radiation therapy through external beam radiation or brachytherapy, freezing or heating prostate tissue, hormone therapy, chemotherapy, immunotherapy, and targeted drug therapy. You and your doctor will work together to determine which option is best for you.

Prostate Cancer That Doesn’t Respond to Treatment

If your blood levels show that your prostate cancer was not effectively cured by treatment, your doctor will recommend further treatment to try and eradicate the cellular mutations. Depending on where the cancer is—if it’s localized or has spread—these treatment options vary. It may require a combination of surgery, hormone therapy, radiation therapy, cryotherapy, or more. Active surveillance is essential in the long-term treatment. 

Understanding the Recurrent Prostate Cancer

Recurrent prostate cancer is when prostate cancer returns after the initial treatment or partial to complete remission has occurred. This is due to the reemergence of surviving prostate cancer cells that have grown large enough to be detected.

Following a prostatectomy, your prostate-specific antigen (PSA) levels being to decrease. Eventually, they are no longer detectible, which is an indication that prostate cancer is no longer present. However, there is no clear reference for a “normal” PSA. It differs between men and can be affected by a number of factors. Following your initial prostate cancer treatment, PSA levels should stabilize and be low enough to where they’re not detected on blood tests. In some cases, PSA levels begin to rise again, indicating a need for further tests.

Even if you’ve had a prostatectomy, prostate cancer can recur in the immediately surrounding tissue, lymph nodes, seminal vesicles, muscles that control urination, the rectum, the wall of the pelvic, or metastasize into lymph nodes and bones further away.

How Common is Recurrence?

The recurrence of prostate cancer depends on when it was caught and treated the first time. If your doctor was able to remove the cancer while it was still confined in the prostate gland, your chances of recurrence are fairly low. If your cancer spread before treatment, such as in the case of about 10% of men, recurrence is more likely to occur. Recurrence, therefore, occurs if not all of the cancer cells were treated the first time or if the cancer was more advanced than originally believed.

Detecting Prostate Cancer Recurrence

If you have recurrent prostate cancer, it’s usually detected during follow up appointments. Once you undergo initial prostate cancer treatment, you’ll need to see your urologist once every few months to monitor your PSA levels and discuss any new symptoms. If your PSA levels begin to rise, it can be an indication that the cancer has returned. Your doctor will use imaging tests to try and locate the cancer and determine the best course of action for a second round of treatment. Tools for detection are continually improving, so be open to suggestions from your doctor.

Factors that Increase Risk of Recurrence

There are many different factors that can help you determine what your risk of recurrence is. Your doctor will go over these during the initial course of treatment, therefore stressing the importance of follow up appointments.

One factor is the involvement of your lymph nodes. If your cancer has metastasized to your lymph nodes, recurrence is more likely. Similarly, the larger the tumor, the more likely that you are to experience complications and rates of recurrence. If the tumor is intertwined or growing into other areas of your body, this also increases risk. The Gleason score is a system of grading your prostate cancer based on severity and localization. The higher the grade, the more likely you’ll experience recurrence. Finally, the stage of prostate cancer affects recurrence rates. When caught early, recurrence is not as likely as cancers that are in stage three or four.

Cancer can be extremely aggressive and will change your life forever. Make sure that you’re doing everything you can to avoid potential problems. Eat well, exercise regularly, and get enough sleep. Strengthening your immune system is a great way to reduce your risk of recurrence.

Follow Up Treatment for Recurrent Prostate Cancer

When diagnosed with recurrent prostate cancer, it’s important to begin treatment as soon as possible. If you did not have a prostatectomy before, your doctor will likely recommend one now. This is important as recurrent prostate cancer is more aggressive and can result in the cancer spreading to lymph nodes and bone if not addressed quickly. In certain cases, when the only sign of recurrent cancer is an increased PSA level, your doctor may recommend a combination of radiation therapy, hormone therapy, chemotherapy, or a combination of treatment efforts.

If your prostate cancer has returned after undergoing hormone therapy, your body may no longer be responding to the hormones. If this is the case, it means one of two situations:

  • Castrate-Resistant Prostate Cancer (CRPC) – this is when your prostate cancer is still growing, regardless of the effect of hormone therapy on testosterone. CRPC may still respond to other types of hormone therapy.
  • Hormone-Refractory Prostate Cancer (HRPC) – this is when the prostate cancer is no longer able to be helped by any form of hormone therapy.

If you have HRPC, you’ll need additional treatment outside of hormone therapy to target the mutated cells. Luckily, options have continued to improve, and many doctors now turn to anti-androgen drugs and even the prostate cancer vaccine Sipuleucel-T (Provenge). The vaccine works to improve your immune system so that your body is more capable of fighting the cancer on its own. Your doctor may also recommend chemotherapy with the drug docetaxel (Taxotere), immunotherapy, targeted therapy, alternative hormone therapies, bisphosphonates, and many promising new medications.

Regardless of if you’ve been diagnosed with prostate cancer, are experiencing recurrent prostate cancer, or are simply trying to take better care of your urologic care, working with a trusted urologist is essential. Always follow your doctor’s recommendations and don’t hesitate to ask any questions you may have. During your treatment plan, Byram Healthcare is here to help you with anything you need along the way.