If initial treatment fails to cure prostate cancer, recurrence can occur, and the prostate cancer cells that remain in the body can become active again.
Related elevation of prostate-specific antigen requires vigilance for recurrence
Usually, after surgery to remove the prostate, the prostate-specific antigen (PSA) level in the blood drops and eventually becomes almost undetectable. After radiation therapy, the PSA drops back down to a stable, low level.
If PSA levels rise at any time after treatment, there may be a local recurrence or a distant recurrence, a condition that requires additional testing.
Recurrence may be local recurrence or metastasis
Prostate cancer may present with a local recurrence that is located in the periprostatic tissue or in the seminal vesicles (the two sacs near the prostate that store semen). The cancer can also attack the lymph nodes around the pelvis or lymph nodes outside the area of the lesion.
Prostate cancer can spread to tissues adjacent to the prostate, such as the muscles that control urination, the rectum, or the pelvic wall; it can also spread with the bloodstream to the bones or other organs, causing a distant recurrence, a phenomenon called metastasis. Those who metastasize via the lymphatic vessels are called lymph node metastases, while those who metastasize via the blood stream are called hematogenous metastases or hematogenous metastases.
How is recurrence detected?
Test PSA levels regularly
After treatment for prostate cancer, patients should follow their doctor’s orders for a series of tests every few months. At each follow-up visit, your doctor will order a PSA blood test, and PSA levels can help indicate whether the cancer has returned.
Reporting the condition in a timely manner
Patients should tell their doctor about any new symptoms that occur, as new symptoms may indicate the need for additional testing. Although PSA screening is effective, it is not yet a perfect test.
Imaging
If PSA results suggest that the cancer has returned or continues to spread, X-rays or other imaging (such as a bone scan) may be needed, depending on the patient’s condition and symptoms.
The doctor will use the radiotracer Axumin with positron emission tomography (PET-CT) to detect and identify the site of cancer recurrence, then perform a biopsy and treat it.
What factors can affect recurrence?
The following signs indicate a recurrence.
The following signs indicate a high likelihood of recurrence or spread of prostate cancer:
- Involvement of lymph nodes. Patients with cancer cells in lymph nodes within the pelvic region are more likely to have a recurrence.
- Tumor size. In general, the larger the tumor, the greater the chance of cancer recurrence.
- Gleason score. The higher the score, the greater the chance of cancer recurrence. After the lab gives the biopsy results, the doctor will inform the patient of his or her Gleason score.
- Tumor staging. Tumor stage is one of the most important factors influencing the choice of treatment and predicting the future progression of cancer.
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How is it treated?
If prostate cancer recurs, subsequent treatment will depend on a number of factors, including the treatment regimen received, the extent of the cancer, the site of recurrence, other concomitant disease, and age.
Endocrine therapy may be an effective treatment, and researchers are developing new drugs that can block the effects of androgens and stop the growth of prostate cancer cells.
In addition, radiation therapy, high-intensity focused ultrasound, cryotherapy, and bisphosphonates may be used to relieve bone pain symptoms, as well as systemic chemotherapy options. In addition, a prostate cancer vaccine, which can fight prostate cancer by boosting the body’s immune system, is still in clinical trials.