The Realities of Prostate Cancer Recurrence

Prostate cancer is the most common cancer found in men. However, when it's caught and treated early, the cure rate is high. After treatment, most men will be able to live cancer free for years, if not for the rest of their lives. In fact, the 5-year survival rate for men with localized prostate cancer is nearly 100 percent. That said, it's still possible to have a recurrence of the cancer, and between 5 to 40 percent of men will experience this. Cancer recurrence is the return of cancer after a period when no cancer cells are detected in the body. Not all recurrences are the same, and not all will require active treatment. Because the risk is present, it's important to be aware of the possibility and know what you can do to lower your risk, plus be knowledgeable about how to proceed in the event it does recur.

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Recurrence of prostate cancer is mostly related to the stage and degree of aggressiveness of the cancer at the time of initial treatment. The higher the stage and the more aggressive the cancer cells at time of treatment, the greater the chance of treatment failure or recurrence of the cancer. There are two ways in which the prostate cancer can return and be detected. The first involves the development of symptoms of recurrence such as leg edema, blood in the urine, progressive fatigue, bone pain and back pain. The second is referred to as a biochemical recurrence, and it involves a rise in the man's PSA (prostate-specific antigen) levels. After treatment for prostate cancer, PSA levels should drop significantly -- to "undetectable levels" post-surgery, and to levels below 0.5 ng/ml after radiation therapy. If some time after treatment there's a consistent rise in the PSA, this indicates that some of the cancer cells have survived and are still making PSA. It should also be noted that PSA may fluctuate for two years after radiation, but not after surgery, for prostate cancer. The important thing about this type of recurrence is to confirm a constant rise. Stable, low PSA levels that don't steadily rise post-treatment may be fine and not necessitate treatment.

When monitoring recurrence with PSA levels, a rise doesn't always require immediate action. The rise in these numbers will occur well before any clinical signs or symptoms manifest themselves. Because the cancer is so slow growing, some people won't show symptoms for years. However, if a steady rise is identified, this indicates either the cancer has recurred in the area where the prostate used to reside ("local recurrence"), or it may indicate the cancer has spread ("metastatic"). There are a number scans, blood tests and parameters that are checked to determine presence of local recurrence vs. metastatic development.

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In cases of local recurrence, there are additional therapies that can be provided with the intention of curing the prostate cancer. The second round of treatment largely depends on where the cancer is located and what treatments have already been done. For a man that has had the prostate removed (radical prostatectomy), radiation therapy sometimes combined with hormone therapy may be the next course of action. If the first treatment was radiation, other options -- including cryotherapy, high-intensity focal ultrasound or robotic/open salvage prostatectomy -- may be considered. In cases of metastatic prostate cancer, there are hormone therapies that slow the growth or advancement of the cancer. Keeping in mind a risk/benefit analysis will help the doctor and patient make the treatment choice that yields the highest chance for cure with the least amount of side effects.

Despite the predestined nature of cancer for many people, there are some correlations with lifestyle that allow men to play a part in their prognosis. Obesity and other health conditions, like metabolic syndrome, have been shown to increase the chances of prostate cancer returning after treatment. In one study of patients who were followed for four years, prostate cancer returned in 32 percent of obese patients, as opposed to only 17 percent of those who were not obese. In addition, patients with metabolic syndrome had a four times higher risk of cancer return than those without the syndrome. Metabolic syndrome includes a group of adverse conditions such as high blood sugar, high blood pressure, obesity and high cholesterol levels. The bad news is that obesity and metabolic syndrome have become increasingly widespread in our country due to lack of exercise and poor eating habits. But the good news is that with some lifestyle modifications, like eating a well-balanced diet, exercising regularly, reducing stress and getting enough sleep, these conditions can be avoided and the risk for prostate cancer recurrence lowered. The entire risk cannot be eliminated, but it should be encouraging to know that every man can at least take some action to help.

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Doctors don't fully understand why cancer recurs in some men and not others, so living a healthy lifestyle to avoid the risk you can, keeping up with doctor visits after your initial treatment and being aware that the risk does exist are the best things you can do to keep your prostate health in check for life.

S. Adam Ramin, M.D., is a board-certified urologist and founder and medical director of Urology Cancer Specialists in Los Angeles. He is on staff at prestigious medical centers such as City of Hope National Medical Center and Cedars Sinai Medical Center in Los Angeles, where he performs robotic laparoscopic prostatectomy. As an expert in prostate cancer and robotic laparoscopic prostatectomy, Dr. Ramin has published numerous peer review articles and research papers on prostate cancer. He has trained numerous urologists in techniques of minimally invasive laparoscopy and robotic surgery. Dr. Ramin has performed over 1,500 laparoscopic and robotic procedures for prostate, kidney and bladder cancers, and he provides patients curative surgery that is extremely precise, preserves sexual function, has minimal blood loss, minimal pain and quick recovery. Visit his website or connect with him on Facebook or Twitter.