Adjusting to Life In Remission and Preventing Recurrence
- “Top Gear” star Jeremy Clarkson, 66, says he’s still adjusting to life as a prostate cancer survivor after an aggressive diagnosis caught early through routine screening, and he’s now focused on staying in the 60% of patients who avoid recurrence (the cancer returning).
- Prostate cancer can return even years after treatment; studies show recurrence is not uncommon, with dormant cancer cells often hiding in places like the bone marrow, where up to 80% of men who die from prostate cancer show metastases.
- Prostate cancer treatment may include surgery, radiation, and/or hormonal therapy. Each treatment method comes with potential side effects such as sexual dysfunction and urinary incontinence.
- One post‑surgery concern has been urine leakage at the reconnection site, though Dr. Randall Lee notes this risk is now far lower thanks to improved visualization during modern procedures: “Nowadays, that is less of a concern.”
- The United States Preventive Services Task Force recommends that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.
- The American Cancer Society recommends that men aged 50 who are at average risk begin screening. Men who are at high risk of prostate cancer should begin screening at age 40. Men with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.
“I try to be positive. I’ve decided to be one of the 60% who don’t have a recurrence,” Clarkson shared in a recent social media video.
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The screening that helps detect prostate cancer early is the prostate-specific antigen test (PSA), which measures the prostate-specific antigen in the blood. An elevated PSA level in the blood does not always mean you have prostate cancer, but it does call for further tests.
RELATED: Check Out SurvivorNet’s Digital Guide to Prostate Cancer.
The results of the PSA test provide a Gleason Score. This score ranges from 6 to 10. The higher the score, the more aggressive the cancer. This score, along with other test results, helps doctors determine if cancer is “low risk,” “intermediate risk,” or “high risk.”
WATCH: How Gleason Grade Determines Treatment
While the exact subtype of Clarkson’s prostate cancer hasn’t been disclosed, one of his biggest concerns has been the possibility of recurrence — the fear that the cancer could return even after treatment.
Expert Resources on Prostate Cancer Treatment
- A Healthy Sex Life Is Possible Following Prostate Surgery
- An Overview of Prostate Cancer Surgery
- Coping With Side Effects From Prostate Cancer Surgery: What To Expect
- Don’t Be Ashamed – The VA Has Treatment To Help Deal With Incontinence After Prostate Cancer Surgery
- Dr. Akshay Bhandari’s Guide To Prostate Cancer Surgery
Understanding Prostate Cancer Recurrence
Prostate cancer recurrence is not all that uncommon. A study published in the medical journal JAMA followed 1,997 men who had undergone prostate removal surgery. Of those, 304 experienced a recurrence, and about 25% of those cases occurred five or more years after surgery.
Researchers believe that dormant cancer cells can hide in the body for years. The bone marrow, in particular, is considered a key hiding place. This is supported by findings published in the International Journal of Cancer, which noted, “In one autopsy study, approximately 80% of the men who had died from prostate cancer possessed bone metastases.”
Other potential reservoirs for dormant cancer cells include the lymph nodes and the prostate bed—the area where the prostate gland once was—though these are more difficult to study.
Researchers have made significant strides in understanding how prostate cancer can spread early—even when it appears to be under control—and then return months or even years later. One key discovery is that the bones are a common site for prostate cancer to spread. In fact, scientists have found dormant cancer cells hiding in the bone marrow of many patients, even when the disease seems confined to the prostate.
Lab studies, mostly using model systems, have also helped uncover how prostate cancer cells can lie dormant for long periods before becoming active again. While treatments like hormone therapy and radiation after surgery have shown promise, experts agree that more research—both in the lab and in clinical trials—is needed to improve outcomes for patients.
Preparing for Prostate Cancer Surgery
Prostate cancer surgery is a highly effective treatment for many men with localized disease. The goal is to remove the prostate gland and surrounding tissues (such as seminal vesicles) to eliminate cancer. This procedure is called a radical prostatectomy.
“The robot has really revolutionized our ability to operate in that small space, to be able to apply fine dissection, tremor, less movements of the hands to dissect these nerves off of the prostate, and at the same time, suture the bladder back to the urethra after the prostate is removed,” Dr. Randall Lee, a urologist at Fox Chase Cancer Center in Philadelphia, tells SurvivorNet.
“Historically, with open surgery … one of the big risks of that was leakage of urine at that connection site. Nowadays, that is less of a concern with the ability to visualize that area in the pelvis.”
WATCH: Robotic Surgery Vs. Open Prostate Surgery For Prostate Cancer
More on Robotic Prostatectomy
A robotic-assisted laparoscopic prostatectomy (RALP) is a minimally invasive procedure that uses a robotic surgical system, such as the da Vinci Surgical System. The surgeon operates from a console, controlling robotic arms that hold surgical instruments and a high-definition 3D camera.
Tiny incisions (usually 5-6) are made in the lower abdomen to insert the instruments. The robotic system translates the surgeon’s hand movements into precise actions inside the patient’s body. The camera provides magnified views that help in identifying nerves and structures crucial to continence (bladder and bowel control) and sexual function.
Both types of prostate cancer surgeries [robotic and open surgery] carry the same general risks, including bleeding, infection, and complications related to anesthesia. However, functional outcomes, particularly urinary continence and erectile function, are of major concern for most patients.
Most men experience some degree of incontinence initially. Robotic surgery may lead to a quicker return to continence due to better precision in preserving structures around the urethra. Long-term incontinence rates are similar between both methods with experienced surgeons.
Nerve-sparing techniques can help preserve erectile function in eligible patients. Robotic surgery may offer a better chance at nerve preservation, though outcomes depend largely on the patient’s preoperative function and cancer location. Full recovery of sexual function can take months or more than a year.
Prostate Cancer Screening and Warning Signs
When you do get screened for prostate cancer, your doctor will run a few tests.
One of the tests is the PSA test, a simple blood test that screens for prostate cancer. It looks for more significant amounts of protein-specific antigen (PSA) in the blood. An elevated PSA test does not always mean you have prostate cancer. It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.
Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.
Depending on the results of these tests, imaging scans and a biopsy may be ordered.
WATCH: How Gleason Grade Determines Treatment
Prostate cancer does not always behave the same in every man it impacts. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about screening.
The United States Preventive Services Task Force recommends that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.
The American Cancer Society recommends that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 40. Men with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.
SurvivorNet experts suggested that men consider factors like their family history, genes, and age when deciding whether and when to screen.
Symptoms of prostate cancer may include:
- Urinating more often
- Waking up in the middle of the night to pee
- Blood in your urine
- Trouble getting an erection
- Pain or burning when you urinate
- Pain in your back, hips, thighs, or other bones
- Unexplained weight loss
- Fatigue
If You’re Diagnosed With Prostate Cancer, What to Expect for Treatment?
After testing and establishing your risk, your doctor will discuss possible treatment options. These may range from active surveillance to more aggressive options, including surgery and radiation therapy.
WATCH: Coping emotionally after a prostate cancer diagnosis
Surgery is an option for men with any risk group of prostate cancer that hasn’t spread outside of the prostate gland. The type of surgery most often used is called a radical prostatectomy.
During the procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Your doctor can perform this through a traditional open procedure with one large or several small incisions, called laparoscopic surgery.
WATCH: Sexual Function Recovery After Prostate Cancer Surgery
Surgery side effects may include erectile dysfunction and urinary incontinence. Fortunately, the side effects are usually temporary, and there are ways to help you manage them.
“Erectile function is so sensitive when we’re dealing with prostate cancer because the nerves that are critical for this function wrap around the prostate; they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, told SurvivorNet.
Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function. This approach actively addresses the psychological, emotional, and relationship impacts on sexual health.
Radiation therapy is often done when prostate cancer is caught early and confined to the prostate gland.
Questions for Your Doctor
If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:
- If I had elevated PSA levels, what could be causing that besides cancer?
- How long will it take to learn if my PSA levels warrant further testing?
- What are the treatment options that are best suited for me based on my risk level?
- What financial resources exist to help me with the costs associated with treatment?
- How long will my potential treatment prevent me from working or continuing normal activities?
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