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Recurrence of Prostate Cancer

 A recurrence of prostate cancer means that the prostate cancer has returned after initial treatment.

After radiation therapy, PSA levels usually drop to a stable and low level.

However, if PSA levels rise at any time after treatment, a local or distant recurrence may be occurring, requiring additional testing.

Prostate cancer can recur in the tissue next to the prostate, or seminal vesicles. Prostate cancer can also recur in bones or other organs, which is called metastasis.

How Common Is Recurrence of Prostate Cancer?

Almost 100% of men with prostate cancer live at least five years after the diagnosis.  91% of men diagnosed with prostate cancer survive at least 10 years and 76% survive 15 years, according to the American Cancer Society. Because many men who are diagnosed with prostate cancer are already elderly, many are more likely to die from other causes.

More than 90% of the time prostate cancer is discovered while it is either confined to the prostate gland or has spread beyond the prostate only to a small degree, referred to as regional spread.

Among the less than 10% of men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis, about 31% are expected to survive at least five years.

How Is a Recurrence Detected?

After prostate cancer treatment, patients should go for medical check-ups every few months as determined by a doctor. Your doctor will order a blood test to measure PSA levels at each appointment. This test helps your doctor detect a cancer recurrence.

When PSA test results will suggest if cancer has come back or is continuing to spread. X-rays and other imaging tests may be done.

What are Signs that Point to Recurrence?

There are several signs that can point to a recurrence of prostate cancer:

  • Lymph node involvement. Men who have cancer cells in the lymph nodes in the pelvic region are more likely to have a recurrence.
  • Tumor size. Often, the larger the tumor is, the greater the chance of recurrence.
  • Gleason score. The higher the grade of cancer, the greater the chance of recurrence to happen.
  • Stage. The stage of a cancer is the most important factor for choosing treatment plans and determining of the cancer will come back.

It is extremely important for men that have been diagnosed with prostate cancer and have gone into remission constantly monitor their progress. Daily checkups are crucial to ensure the identification of prostate cancer recurrence.

What is PSA Flare?

It is important to note that there can be an initial transient surge in serum PSA during the first six to eight weeks of treatment followed by disease stabilization and decrease in PSA. This occurs with docetaxel so a decision to discontinue treatment should be not be made until 2-3 months have elapsed unless very significant side-effects occur.

Are there other options for castrate-resistant prostate cancer?

  • Abiraterone acetate – On April 28, 2011, FDA approved abiraterone acetate (Zytiga® Tablets) for use in combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer who have received prior chemotherapy containing docetaxel. Zytiga® is a novel, targeted, oral androgen biosynthesis inhibitor that prevents cancer cells from producing their own testosterone.
  • Cabizitaxel – On June 17, 2010, FDA approved cabazitaxel (Jevtana® Injection) for use in combination with prednisone for treatment of patients with metastatic castration-resistant prostate cancer previously treated with a docetaxel-containing regimen. Cabazitaxel is a chemotherapy that is similar to but distinct from docetaxel. Toxicities for cabazitaxel include low white blood cell counts, “febrile neutropenia” and diarrhea. Approximately 5% of the worldwide treated patients died from side effects attributable to the drug however in North America the death rate was less than 1% of the treated patients. Infections and kidney failure were responsible for the majority of the deaths.
    See: New FDA Approval for Cabazitaxel (Jevtana®)
  • Docetaxel combinations – If prostate cancer progresses when treated with docetaxel, combinations with other pharmaceuticals may provide a renewed response. Some possible drugs include:  Thalidomide, Carboplatin, Capecitabine, Estramustine, Revlimid®, Avastin®
  • Mitoxantrone – is approved for prostate cancer and has been shown in clinical trials to provide palliative relief for prostate cancer pain but has not demonstrated a survival advantage.
  • Other chemotherapies – There are a number of other chemotherapy drugs that are approved for a variety of cancer and can be used off-label for prostate cancer. Since each prostate cancer case is different, many patients can obtain at least temporary control with one or more of these as a single treatment or in combination. This may be especially true for prostate cancer variants that demonstrate neuroendocrine characteristics. Several that have shown some benefit include: carboplatin, cyclophosphamide, doxorubicin, epirubicin, estramustine, etoposide, paclitaxel, vinblastine, vinorelbine.
  • For more information – see: New Therapies In Clinical Trial for After Docetaxel Fails