After Treatment

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Once you've completed primary treatment for prostate cancer, you may be concerned about recurrence (the cancer returning). It is a common concern for men and their doctors. Prostate cancer will recur for some, but not all, prostate cancer patients. This is why a monitoring plan is important for men who have been treated for prostate cancer.
After primary treatment, it is not clear which prostate cancer patients are likely to have their cancer come back. In some patients, prostate cancer may recur many years after the primary treatment. For other patients, the prostate cancer may return more quickly. A monitoring plan can help your doctor identify prostate cancer as soon as it returns. It's a good idea to discuss the follow-up plan with your doctor and how monitoring your health will be an important part of your health program for the rest of your life. If you've changed doctors since your primary treatment, make sure your new doctor has a complete set of records from your previous doctor and hospital.
One important tool your doctor may use to help determine your risk of prostate cancer returning is a PSA (Prostate-Specific Antigen) test.
About your PSA test
As you probably know, the PSA (Prostate-Specific Antigen) test is a simple blood test to measure the level of PSA in the blood. You are probably already familiar with this test. Initially, this test helped your physician detect the presence of cancer in the prostate. Now that you have received primary treatment, the PSA test will continue to be an important monitoring tool because it can help your doctor determine the risk of prostate cancer returning. Your doctor may want to establish a regular monitoring program to watch how PSA levels may change over time, focusing on three areas.
How high the PSA level rises
The amount of time that goes by before the PSA level starts to rise
The amount of time it takes for the PSA level to double. This is called PSA doubling time or PSA-DT
PSA changes
After you have received primary treatment for prostate cancer (for example, radiation or radical prostatectomy), you need to discuss with your doctor what a normal PSA range will be for you. Your PSA level can change over time and this can be due to causes other than prostate cancer returning. A PSA level can be stable for months or even years at a time, or it may go up a little, alot, or none at all. It's important for your doctor to monitor your PSA level and to discuss any rise in your PSA level with you. If your PSA level does rise, your doctor may want to look closely at how high the PSA level rises, the amount of time that goes by before the PSA level starts to rise, and the amount of time it takes for the PSA level to double (PSA doubling time). Usually two or more tests are required, often over a period of several months.
Other tests
PSA tests are not the only tests your doctor might use to help him or her determine the risk of the prostate cancer returning. Since you have already received primary treatment for prostate cancer, your doctor already knows something about the way the cells looked and were arranged in the prostate cancer. The appearance and arrangement of prostate cancer cells are usually graded by a system known as the Gleason grade. The Gleason grade of the original tumor may be from biopsy samples or taken from the whole prostate after it was removed if you underwent a prostatectomy. Your doctor can use the Gleason grade you already have in combination with your PSA information to help determine your risk for prostate cancer returning. If your doctor determines you are at high risk of prostate cancer returning, what next steps should be taken? As a first step, it’s important to talk to your doctor. Your doctor will work with you to determine what additional tests may be appropriate.
Keep a positive outlook
Prostate cancer may bring up feelings that you may find hard to deal with. Take advantage of all the help you can find, especially from your health care team. Tell them what you are thinking and what you need. There is no one way to react to prostate cancer, and every man is entitled to his own experience. If you need to find an outside group or resource to help, call the American Cancer Society at 1-800-ACS-2345.
Stay involved
Become a partner with your health care team (your urologist, radiation oncologist, medical oncologist, nurse, technician, counselor). Ask questions. It's a good idea to write down all your questions and answers so you can refer to the information at any time. Once a prostate cancer management plan is in place, follow your health care team's advice and let them know about any new symptoms or other concerns.
For more information about recurring prostate cancer, talk to your doctor.