The 5-year survival rate of the majority of prostate cancer cases is nearly 100%.1 Numbers like these indicate that although receiving a diagnosis of prostate cancer and undergoing varying treatment options can be stressful, for many, the result is positive. It is possible for prostate cancer to be “cured” and for individuals to be in complete remission. Successful curative treatment will destroy or completely remove all signs of prostate cancer. Although treatment is effective and efficient in many cases, there is still a possibility for both progression of the cancer or recurrence later on.
Terms to know
When considering prostate cancer’s progression or recurrence, it is important to have a basic understanding of what these terms mean.
When a cancer spreads or gets worse. Progression can happen after surgical treatment options fail to remove all of the cancer, or when an individual’s cancer is not responding to treatment. Prostate cancer starts locally, and can progress to be classified as regional (meaning it has spread slightly beyond the prostate and into the surrounding lymph nodes) and distant (meaning the cancer has spread well beyond the prostate to infiltrate other lymph nodes or organs within the body).
When cancer an individual is deemed cancer-free and remains this way for a period of time, only to have the cancer return at a later date. The cancer’s return can be of a similar severity as before, or can be more advanced or distant. Although the cancer’s return can vary in prognosis, typically, the shorter the amount of time between being cancer-free and the first sign of recurrence, the poorer the prognosis.
Controlled prostate cancer:
When cancer is still present within an individual but it is not changing.
Castrate-resistant prostate cancer (CRPC):
Testosterone levels are decreased to the same levels as if castration had taken place, either with surgery or medication, but the cancer is still progressing. Other hormone therapies may still be an option.
Hormone-refractory prostate cancer (HRPC):
The cancer has progressed beyond, or is resistant to all hormone therapies.
Different than recurrence, second cancer is when another form of cancer separate from the original is found. This cancer is independent from any others an individual has previously encountered and is not due to a primary cancer spreading.2
What happens after treatment?
If treatment is successful, levels of PSA (prostate-specific antigen) in the blood will decrease. PSA levels can rise substantially when an individual is battling prostate cancer, and these levels are used as an early indicator of potential cancer. When prostate cancer is successfully treated using radiation therapies, PSA levels will drop to lower levels and stabilize. When prostate cancer is successfully treated by surgically removing the prostate, PSA levels will decrease to the point of being virtually undetectable. When monitoring for recurrence of prostate cancer, one common method is to monitor PSA levels in the blood. If the prostate cancer returns, it is likely that PSA levels will rise again.
If treatment is unsuccessful, and the cancer is unable to be controlled, it can spread to the tissues and lymph nodes surrounding the prostate, as well as to the rectum, muscles that control urinary functions, or pelvic wall. From here, the cancer can then progress to become classified as distant, traveling through lymph channels or the bloodstream to affecting far away organs or organ systems. At this point, the cancer has metastasized. If the cancer does progress to this point, what is also called advanced cancer, your doctor will help you determine what treatment options, if any, are best for your situation. If the cancer has progressed beyond curative options, treatments may be focused on comfort care and alleviating pain instead.
Follow-up recommendations and survivorship plans
Each case of prostate cancer can vary, which is why your provider will help determine the best follow-up care plan for you. Factors that might influence your specific follow-up plan include age, extent of cancer, other health conditions, medications taken, and site of recurrence if the cancer has recurred previously. Most likely, you will be returning for check-ups every few months that will include blood tests to monitor PSA levels. Each time you return, you will be examined and asked if you’ve noticed any new or concerning symptoms. If needed, X-rays and other scans may be completed in order to monitor for recurrence or progression.
Rising PSA levels may be indicative of a potential recurrence; however, this recurrence may not be causing significant harm. In some instances, recurring prostate cancer may be incredibly slow growing to the point that costs and side effects of treatment could be greater than any benefits. Active surveillance during these times may be a good option, and will be determined by you and your provider. Although follow-up appointments and tests vary, typical guidelines recommend a follow up PSA test and DRE (digital rectal exam) within a few months of treatment, and then recurrent PSA tests every 6 months or so for the first five years post-treatment. After the five-year mark, PSA tests often extend to yearly. However, these numbers are just average guidelines, and may vary based on the stage of the initial cancer and an individual’s risk of recurrence.
Your provider may also assist you in creating a survivorship plan, consisting of a suggested schedule of follow-up visits, a list of potential late-developing side effects to watch for, symptoms to look for, physical activity and diet suggestions, and other support sources. Cancer can recur well after treatment, even years down the line. This is why it is important to follow your survivorship plan and adhere to your specific follow-up schedule.2-4
Reducing risk of progression and second cancer occurrence
Although there are no guaranteed ways to halt the progression of prostate cancer, stop the cancer from coming back, or to prevent a second cancer, there are healthy behaviors that an individual can practice in order to keep their body in the best condition possible to fight whatever comes along. Several of these behaviors include:
- Maintaining a healthy diet and weight
- Engaging in regular physical activity (within reason)
- Quitting smoking
- Seeking emotional and mental support (if necessary)2,3
More research is needed to determine the extent of the benefits these lifestyle changes can bring to individuals with prostate cancer.