Will Your Prostate Cancer Recur after Surgery?
by Robert Warren Hess
If you have prostate cancer and you have your prostate removed (radical prostatectomy), can your cancer return? If it does return, are there treatment options available? These are questions men ask when they are faced with making a decision about prostate cancer treatment. Unfortunately, the answer to the first question is “yes” while an affirmative to the second question is (fortunately) a positive sign. If you are faced with making a treatment decision about prostate cancer that involves prostatectomy, it’s a good idea to learn all you can about the procedure and other cancer treatments so you can be prepared to tackle a possible return of your prostate cancer.
Chances Prostate Cancer Will Recur
Overall, a man who has undergone prostatectomy for localized prostate cancer has a 10 to 30 percent chance of experiencing prostate cancer recurrence during his lifetime. Among these cases of recurrence, about half happen during the first three years after prostatectomy, another 30 percent occur from years 3 to 5 post-prostatectomy, and about 19 percent happen after year 5. Some experts say the figure of recurrence is even higher.
Why Prostate Cancer May Return
Prostatectomy as a treatment option for prostate cancer is usually chosen by men who have localized prostate cancer; that is, it has not spread beyond the prostate gland. Therefore, the hope is that removal of the prostate will also rid the body of prostate cancer cells. A prostatectomy can be performed as either a traditional open surgery, a laparoscopic procedure, or as a robot-assisted approach (computer-enhanced robotic prostatectomy). Most men who are candidates for traditional open prostatectomy can have a laparoscopic or robotic prostatectomy.
While recovery times and the risk of postoperative symptoms and complications differ depending on which type of prostatectomy you choose, the burning question after surgery is whether the cancer will come back. You may wonder how prostate cancer can recur if the diseased prostate has been removed.
Although a man may have prostate cancer that appears to be entirely localized (limited to the prostate), it is possible for some prostate cancer cells to migrate outside the prostate and beyond the surgical area, which includes not only the prostate but the tissue surrounding it that is removed during surgery.
There is no way to know for certain if prostate cancer cells have migrated outside the surgical area, and so it is these cells that may trigger a cancer recurrence. That’s why men who undergo prostatectomy are told to have a PSA test regularly, typically every six months for at least 10 to 15 years. In addition, many men choose to have radiation therapy following prostatectomy to kill any cancer cells that may have migrated.
For men who have a prostatectomy and whose prostate cancer is limited to the prostate and whose tissue surrounding their prostate and lymph nodes are free of migrating prostate cancer cells, survival is similar to that of a man who never had the disease at all. However, then there are men who have rogue cancer cells, and they face the possibility of needing to treat recurring prostate cancer.
Treatment Options for Prostate Cancer Recurrence
The two treatment options for prostate cancer that has recurred after prostatectomy are radiation and hormone therapy. Some physicians recommend radiation therapy alone, while others suggest a combination of radiation and hormone therapy. In many cases, physicians suggest starting radiation therapy for prostate cancer when the PSA level rises above 0.2 ng/mL and remains there for two consecutive readings. Hormone therapy often is not started unless the PSA level rises above 0.4 ng/mL, however, each case is unique and so you need to consult with your healthcare provider.
Studies of Prostate Cancer Recurrence
At the University of California, San Francisco, investigators reported that 15 percent of 1,439 men who underwent prostatectomy experienced recurrence. Prostate cancer recurrence was defined as:
- a PSA (prostate-specific antigen) level of 0.2 ng/mL or greater on two consecutive tests, or
- the patient needed a second cancer treatment at least six months after surgery
Another study extended that 15 percent figure to 40 percent, noting that this was the number of men who will experience prostate cancer recurrence within 5 years.
If you want to improve your chances of survival after prostatectomy, a course of radiation therapy may be in order, as already mentioned. The potential benefit of radiation therapy after prostate removal was explored in a study published in the Journal of the American Medical Association.
The researchers evaluated 635 men who had a prostatectomy between 1982 and 2004 and then followed up through 2007, evaluating the number of men who had a recurrence of prostate cancer and received no treatment (397 men), radiation treatment (160 men), or radiation plus hormone therapy (78 men).
At a median of six years after prostate cancer recurrence and nine years post prostatectomy, a total of 116 men (18%) had died of prostate cancer. They included the following:
- 89 men who were not treated after cancer recurrence
- 18 men who underwent radiation treatment only
- 9 men who received both radiation and hormone therapy
Overall, the researchers found that giving radiation therapy after prostatectomy and the recurrence of prostate cancer was associated with a nearly 60 percent reduced risk of death and threefold increase in prostate cancer-specific survival when compared with men who did not undergo any treatment at cancer recurrence. Radiation was also associated with a significant increase in overall survival. Notably, the addition of hormone therapy to radiation therapy did not improve survival.
Also notable in this study are the following findings:
- The increase in prostate cancer-specific survival associated with radiation therapy was seen only in men who had a PSA doubling time of less than six months. Among the 166 men who met this description, radiation as well as radiation plus hormone therapy were associated with a greater than 75 percent reduced risk of prostate-cancer specific death.
- Men who started radiation therapy more than two years after their cancer recurred did not experience a significant increase in prostate cancer-specific survival.
- Men whose PSA levels never reached zero after they had radiation therapy post prostatectomy did not experience a significant increase in prostate cancer-specific survival.
What to Do When Radiation and Hormone Therapy Fail
For some men, radiation and hormone therapy do not put the brakes on prostate cancer that recurs after prostatectomy, and the disease continues to spread. In such cases, one treatment option may include chemotherapy with docetaxel (Taxotere), which may extend survival and effectively treat cancer pain. Another option is the immunotherapy sipuleucel-T (Provenge), which for now is limited to men with metastatic prostate cancer who have no symptoms or whose cancer pain does not require use of narcotics and who have not responded to hormone therapy.
Two other choices for men who have not responded to traditional hormone therapy are abiraterone (Zytiga), a form of hormone therapy that has been approved by the Food and Drug Administration (FDA) for advanced cancer that has resisted previous hormone therapy; and enzalutamide (Xtandi), which is approved for men whose prostate cancer has spread and not responded to both hormone therapy and chemotherapy (docetaxel).
For the majority of men who undergo prostatectomy for localized prostate cancer, the disease does not recur. However, for those men who do experience prostate cancer recurrence, there are treatment options, and patients should discuss the risks and benefits of all the alternatives with their healthcare providers and loved ones before making a decision.
*This article was written by Doborah Mitchell and published at Prostate.net on September 23, 2012. You can access the original article at the following link: http://www.prostate.net/2012/prostate-cancer/prostate-cancer-recurrence-after-prostatectomy/
My Takeaways from This Article
I’m not a doctor or a medical services provider, just an eleven-year prostate cancer survivor, so the following comments are just my opinion and should be considered as such.
I read in the article that between 15-40% of men who undergo a radical prostatectomy for localized prostate cancer will experience a recurrence of the disease. This reinforces for me the absolute criticality of detecting prostate cancer at the earliest possible stage. That means beginning an annual prostate cancer screening program (currently the PSA test is the best available) at age 35 and personally tracking any changes from one year to the next.
Secondly, it’s just as critical to know if you have an aggressive form of prostate cancer. Your pathologist will play a critical role here, because the pathologist dissects the prostate tissue following surgery and gives the prostate cancer a Gleason grade, showing how advanced it is.
This article suggests that men diagnosed with aggressive prostate cancer should go through a course of radiation treatment. I can’t comment medically on that suggestion, but this seems to me to be a logical course of action. I was not given localized radiation therapy following my surgery nor was it even mentioned. At 13 years since surgery my PSA remains at .04 – .06, so perhaps I’m in the non-recurrence bucket – but maybe not. One never knows. I wish I had been advised about other additional treatment options following my surgery.
But, what else can a prostate cancer survivor do to prevent or delay recurrence? I believe that diet and exercise can play a key role – I believe it has for me – and I’m going to be writing more about that in this blog.
Immediate Next Step
Activate your free prostate cancer early detection account at ProstateTracker.org. ProstateTracker works for men both before and after prostate cancer diagnosis. ProstateTracker is your personal, free, and anonymous “canary in the coal mine” that will show you if you have a rising PSA trend, which equates to a rising risk of having prostate cancer.
ProstateTracker also sends an email reminder when your next PSA test is due.
Prostate cancer kills almost 30,000 men every year and you have no early symptoms. Early detection is priceless. Create your free, anonymous account early warning account right now: ProstateTracker.org.
It saved my life.
December 7, 2012
generally speaking, suergry and radiation is the protocol sometimes with chemo added on top of those things. Research just hasn’t gotten beyond that yet, unfortunately. However, depending on the hospital you’re treated at, there may be clinical trials available. For information on clinical trials, visit clinicaltrials.gov
August 15, 2013
Mr. Hess, thank you so much for you non medical but survivor background research and view of the topic. As a 3 year survivor of radical prostatectomy, this is invaluable information. I had no idea the return rate was as high as 40%. I fall into the same category as you do and I have been attentive to the issue and subject. Bases on your article I will now be VIGILANT.
August 15, 2013
Hi Louis. I’m not perfect, but I definitely try and stay pretty close to my anti-cancer diet and exercise program. My best wishes to you. Robert
February 17, 2014
Hello Robert – I am about 1.5 years into my post radical prostatectomy. My Gleason score was 10 and had follow up radiation and am now doing Androgen hormone therapy for a second time. My PSA steadily went down to undetectable from July 2012 to Oct 2013, but in Jan. 2014 it has jumped to 0.5. I would be very interested in hearing about your anti-cancer diet. Thank you – Jon
February 27, 2014
As a fellow survivor Prostate cancer survivor I thank you for your time spent in creating and managing this web site. I think it is worth mentioning the value of the national group “US-TOO” which is dedicated to educating and helping men when they learn they have Prostate cancer. I was diagnosed in Nov. 1998 and had the radical prostatectomy surgery in March of 1999. I have been fortunate to not have a recurrence. Us-Too is another resource avaialble for all men and their partners to learn about the disease and the options for treatment. I have served on the local chapter board and several of our members have served on the national board. Most men do not know that 1 in 6 will experience prostate cancer in their lifetime and the odds drop to 1 in 3 if your brother-dad has the disease. My younger brother just had succesful surgery and his PSa is at 0.00 after 2 months. If I can be of any help to others [please let me know.
March 18, 2014
Hi Fred: Thank you for your post. Us-Too is a great organization and the leadership team and the many volunteers nationwide do great and important work. We have a link to Us-Too here on our website – Us Too National Website. Any thank you for your offer to help. One of the best ways to reduce the prostate cancer death toll is to get men testing early and tracking their results. Just point guys – better yet, their ladies – to http://ProstateTracker.org. Warm regards, Robert
Preventing Prostate Cancer Recurrence – the 2015 Story | The Prostate Cancer Awareness Project, a registered 501 (c)(3) not-for-profit prostate cancer advocacy organization
December 29, 2014
[…] Will My Prostate Cancer Recur? That is the number one question we get asked here at PCAP and it also is the number one search phrase that brings people to our website, by a factor of 5! I wrote a detailed post about prostate cancer recurrence that you can read at the following link – likelihood of prostate cancer recurrence. […]
January 19, 2015
March 3, 2015
Well guys, I had my radical prostatectomy on 10/11/ 2014.
Gleason score was 3+4 and t2a. pre op Psa 6.8
Psa on 10/12/14 was 0.13
Psa on3/3/15 was 0.23
Seems I always tend to end up on the wrong side of the stats!!!!
So it seems that some bug is still there.
Considering radiation, but will wait untill my 6 mnths Psa.
Would like to hear about the diet.
March 6, 2015
Sorry to hear that your PSA seems to be rising. T2a would seem to indicate that it had not spread, but I guess your doctors have checked for that.
I will begin posting my recipes in the blog in the near future and talking about some of the news tools that I’m using in my own cancer battle.
What are your eating habits? Are you on the veggie side of things or more traditional meat and potatoes?
February 7, 2016
m sumit from india… my english is’t so gud hope u’ll understand wht i am trying to say… on 3-2-2016 my dad check his PSA level cz doctor advised him for checkup .. and his PSA found on report is 11.96 this was so high so we go on another dignostic center again we found it high and PSA was 9.98 …. now doctor advise for biopsy… i cant understand the meaning of PSA ….is this PSA test is proof of prostate cancer….?? HOW much possibilty of prostate cancer on 9.98 PSA ….
February 8, 2016
PSA stands for prostate specific antigen. It is a protein in the blood that is a marker for prostate cancer. However, elevated PSA’S can come from a case of prostatitis, which is an inflammation of the prostate and not prostate cancer. The next step often is a course of antibiotics to stop any infection and then a re-test of the PSA to see if it still is high. If the PSA is still high, you should follow the course of treatment recommended by your physician.
February 8, 2016
I need support advice everything. mu husband has been diagnosed with prostate cancer. Gleason 7 going for a radical prostatectomy on march 1st. all this has been so devastating for me our family. I need guidance. I am so so scare.
Darren M. Ward
February 16, 2016
Dania, Yes when you first find out it is pretty scary. May 8th 2015 I had a 3.99 PSA sent for 24 sample biopsy mid may 1 sample came back positive Gleason 3+4=7 May 25th had had radical prostatectomy with the da vinci robot nerve sparing had a catheter for 10 days normal is 7 the OP itself was not bad at all not much pain to speak of afterwards. sex still works pretty good a little different but good. 9 months out PSA 0.02 undetectable. wishing you and your husband all the best im sure when its all done he will say it wasn’t that bad. Just try not to let the mind games get to you so much that is the worst part more so then the OP. Good Luck
What Are The Chances Of Prostate Cancer Returning After Surgery - Prostacet for men
June 28, 2018
[…] Will Your Prostate Cancer Recur after Surgery? – Chances Prostate Cancer Will Recur. Overall, a man who has undergone prostatectomy for localized prostate cancer has a 10 to 30 percent chance of experiencing prostate cancer recurrence during his lifetime. […]