Monitoring & Recurrence After Prostate Cancer Treatment
- After treatment for prostate cancer, you will be monitored regularly with a PSA blood test. However, a rising PSA level doesn’t always mean cancer has returned.
- If higher levels of PSA are detected, your medical team may order an additional test followed by imaging to confirm the diagnosis.
- It’s important for patients to understand that while recurrences do happen, there are still many different treatment options available.
- Local recurrences can sometimes be cured — and even metastatic recurrences are often controlled for years with hormone therapy and targeted treatment.
Regular monitoring with PSA blood tests is a necessary part of life post-treatment. When an elevated PSA level is detected during a routine screening, even if it’s just a bit, it’s often enough to trigger anxiety, suffering, and questions for patients.
Read MoreYour healthcare team will look for a pattern over time and order additional tests as needed. Once recurrence is detected, the focus turns to where the cancer might be and what can be done to control it next.
How Is Recurrence Detected?
After surgery (called prostatectomy), in which the entire prostate was removed, the PSA should fall to undetectable levels, because the prostate is the site of production and release of this substance. In this setting, recurrence is usually defined as a PSA ≥ 0.2 ng/mL on two separate tests.
That second test is paramount to confirm that the change is steady and not a lab error. After radiation therapy, some normal prostate cells can remain, so PSA does not go to zero. Instead, your current PSA is compared to your personal lowest point (your nadir). Recurrence after radiation is commonly defined as nadir + 2.0 ng/mL. In some patients, a small, temporary “PSA rise” can happen in the first couple of years after radiation; it settles on its own and is not a true recurrence.
There are different forms of recurrence: biochemical recurrence, local recurrence, and metastatic recurrence.
- Biochemical recurrence means only the blood test has changed; scans might still be negative.
- Local recurrence means cancer is found where the prostate used to be or inside the gland after radiation.
- Metastatic recurrence means it has moved to lymph nodes, bones, or other organs.
It is important to clarify that if you are on hormone therapy and the PSA rises despite very low testosterone, that is called castration‑resistant prostate cancer (CRPC). CRPC does not mean “no options” — it means you’ll need to change strategy, often by adding or switching treatments that block the androgen pathway more completely.
Treatment Options After Recurrence
Once recurrence is confirmed, the next step is to consider imaging to locate the disease.
“If it is progressing, then it says, let’s understand where the cancer is and see what we can do about it,” Dr. Kelly says.
If recurrence is local, meaning it has not spread to distant parts of the body, there is still a chance for cure.
After metastatic recurrence, long‑term control is the goal rather than cure. Today’s therapies can keep the disease quiet for years while you stay active and engaged in life, Dr. Kelly notes.
“It’s important to give patients hope,” he adds.
Your medical team should go over standard approaches as well as what’s new and in development and may be available in a clinical trial.
Questions To Ask Your Doctor
- How frequently will you order my PSA levels to check for recurrence?
- How do we know if the rise is a lab error or a true recurrence?
- Is there any difference in treatment and prognosis if my recurrence is early or later after the surgery?
- Are there any clinical trials I might be a good fit for?
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