Although you may have prostate cancer that appears to be entirely localized (limited to the prostate), it is possible for some prostate cancer cells to migrate outside the prostate and beyond the surgical area, which includes not only the prostate but the tissue surrounding it that is removed during surgery.
There is no way to know for certain if prostate cancer cells have migrated outside the surgical area, and so it is these cells that may trigger a cancer recurrence. That’s why men who undergo prostatectomy are told to have a PSA test regularly, typically every six months for at least 10 to 15 years. In addition, many men choose to have radiation therapy following prostatectomy to kill any cancer cells that may have migrated.
About 30-45% of conventional prostate cancer treatments resurrects after the five-year mark and begins to show signs of disease recurrence. ; Mostly depends upon the patient’s lifestyle. Some prostate cancers also decide to be in its state of calmness or dormancy and will not cause any problem and some factors activate them.
A rising PSA is typically the first sign seen, coming well before any clinical signs or symptoms. Overall, a man who has undergone prostatectomy for localized prostate cancer has a 10 to 30 percent chance of experiencing prostate cancer recurrence during his lifetime. Among these cases of recurrence, about half happen during the first three years after prostatectomy, another 30 percent occur from years 3 to 5 post-prostatectomy, and about 19 percent happen after year 5.
Some experts say the figure of recurrence is even higher and also depends upon race.
Being born again prostate cancer as I call it, is also likened to a resurrection, but nowhere does the Bible show resurrected people as begotten as a fetus confined to a womb. Rather, Scripture shows the converted as adults freed from spiritual death and at liberty to move about, live life, make choices, and interact with others, putting their new spiritual life to practical use.
Prostate cancer is considered one of the most “curable” forms of cancer, with an overall five-year survival rate of 98 percent. But for many men, the fear of cancer persists long after the cancer itself is gone. It’s normal to think: “What if it comes back?” In fact, some research estimates that as many as 70 percent of cancer patients are plagued with anxiety over a relapse. It’s important to discuss these feelings, deal with them, and know what your risks are. Armed with this knowledge, you can take steps to reduce the risk of your prostate cancer recurring.
Prostate Cancer Recurrence Risk Factors
First, you should understand what your risk of recurring prostate cancer really is. According to the Prostate Cancer Foundation, about 90 percent of all prostate cancer cases are diagnosed in the local or regional stages, when the five-year survival rate is nearly 100 percent. Most men will be cancer-free throughout that time and beyond. But in about 20 to 30 percent of cases, the cancer will relapse after the five-year mark.
If prostate cancer does come back, it can come back in (or close to) the site of the original cancer, which is called a local recurrence. It can also show up in the bones or other distant places, which is called a metastasis.
Here are risk factors you should know to help determine if your prostate cancer is likely to return:
The stage of your cancer at diagnosis. The higher the stage of prostate cancer at diagnosis, the greater the likelihood of a recurrence.
Where the cancer spread. If your prostate cancer spread to the lymph nodes, you may be at an increased risk of recurring prostate cancer.
The tumor itself. The larger the tumor at diagnosis, the greater the risk of a prostate cancer recurrence.
Your Gleason score. This system measures what type of cancer cells are in the tumor, and how aggressive they are. The higher the score, the greater the risk of prostate cancer recurrence.
There are also certain warning signs at the time of the initial diagnosis that the prostate cancer could recur. During the biopsy that initially diagnoses prostate cancer, doctors might find certain measures of aggressiveness that could indicate the likelihood of a recurrence, says Durado Brooks, MD, director of prostate and colorectal cancer at the American Cancer Society. “Very aggressive tumors tend to recur,” says Dr. Brooks.
Taking Action Against Prostate Cancer Recurrence
It’s important to understand that treatment options are still available, even if your prostate cancer does recur.
Which prostate cancer treatment is best will depend on the treatment you first received to battle the cancer. Radiation and chemotherapy are options to treat recurring prostate cancer, as is hormone therapy. Although vaccines against prostate cancer are being tested and studied, nothing is available yet.
The likelihood of recurrence is also connected to the quality of care received during your initial treatment.
“Find out what the statistics of recurrence is in whatever treatment center that you’re in,” says Brooks, “and make sure those are on par with what can be found around the country.” What you really want, he says, is to be treated in a center that handles many cases of prostate cancer, and by doctors who are expert in this field. “Physicians who treat a lot of prostate cancer patients have lower rates of recurrence, lower rates of complications associated with treatment.”
If the prostate cancer recurs, the treatment options you will be offered will depend on how you were treated in the first place.
If the initial treatment was surgery, then you’ll receive radiation, Brooks says. If you chose radiation as your first treatment, you cannot have surgery for the follow-up.
“Treating recurrence after surgery is a little easier,” Brooks says. The next levels of treatment for any kind of recurrence tend to be similar and involve different types of hormonal manipulation. “Those seem to slow down disease progression for an extended period of time, so it is possible to control recurrent prostate cancer.”
Dealing With Your Fear
You should discuss concerns of prostate cancer recurrence with your doctor, and perhaps a mental health professional. Fear and anxiety can lead to depression and other emotional and mental health issues. But talking about the concerns and educating yourself on your risks and treatment options can help in preparing for what may happen
Treatment Options for Prostate Cancer Recurrence
the two treatment options for prostate cancer that has recurred after prostatectomy are radiation and hormone therapy. Some physicians recommend radiation therapy alone, while others suggest a combination of radiation and hormone therapy. In many cases, physicians suggest starting radiation therapy for prostate cancer when the PSA level rises above 0.2 ng/mL and remains there for two consecutive readings. Hormone therapy often is not started unless the PSA level rises above 0.4 ng/mL, however, each case is unique and so you need to consult with your healthcare provider.
Studies of Prostate Cancer Recurrence
At the University of California, San Francisco, investigators reported that 15 percent of 1,439 men who underwent prostatectomy experienced recurrence. Prostate cancer recurrence was defined as:
a PSA (prostate-specific antigen) level of 0.2 ng/mL or greater on two consecutive tests, or
the patient needed a second cancer treatment at least six months after surgery
Another study extended that 15 percent figure to 40 percent, noting that this was the number of men who will experience prostate cancer recurrence within 5 years.
If you want to improve your chances of survival after prostatectomy, a course of radiation therapy may be in order, as already mentioned. The potential benefit of radiation therapy after prostate removal was explored in a study published in the Journal of the American Medical Association.
The researchers evaluated 635 men who had a prostatectomy between 1982 and 2004 and then followed up through 2007, evaluating the number of men who had a recurrence of prostate cancer and received no treatment (397 men), radiation treatment (160 men), or radiation plus hormone therapy (78 men).
At a median of six years after prostate cancer recurrence and nine years post prostatectomy, a total of 116 men (18%) had died of prostate cancer. They included the following:
89 men who were not treated after cancer recurrence
18 men who underwent radiation treatment only
9 men who received both radiation and hormone therapy
Overall, the researchers found that giving radiation therapy after prostatectomy and the recurrence of prostate cancer was associated with a nearly 60 percent reduced risk of death and threefold increase in prostate cancer-specific survival when compared with men who did not undergo any treatment at cancer recurrence. Radiation was also associated with a significant increase in overall survival. Notably, the addition of hormone therapy to radiation therapy did not improve survival.
Also notable in this study are the following findings:
The increase in prostate cancer-specific survival associated with radiation therapy was seen only in men who had a PSA doubling time of less than six months. Among the 166 men who met this description, radiation as well as radiation plus hormone therapy were associated with a greater than 75 percent reduced risk of prostate-cancer specific death.
Men who started radiation therapy more than two years after their cancer recurred did not experience a significant increase in prostate cancer-specific survival.
Men whose PSA levels never reached zero after they had radiation therapy post prostatectomy did not experience a significant increase in prostate cancer-specific survival.
See you next week
Dr. Raphael Nyarkotey Obu is a registered alternative medical practitioner who specializes in prostate cancer and studied the Masters program in prostate cancer-Sheffield Hallam University, UK. He is a PhD student, Indian Board of Alternative Medicines Academy, Kolkata, India and the founder of Men’s Health Foundation Ghana and De Men’s clinic & Prostate Research Lab in Dodowa, Akoto House. Tel: 0541090045, 0500106570. E.mail:[email protected]