Systemic therapies

What happens if prostate cancer returns after radiation or surgery?

If your prostate-specific antigen (PSA) numbers rise after a definitive therapy, such as surgery or radiation, for most patients, there will be no other evidence of the disease. That’s good news because, in most cases, treatment is unnecessary right away.

If your PSA is rising, a bone and CAT scan is usually ordered to see whether the cancer has spread. If the prostate cancer does spread, the vast majority of cases show in the bones first, then the lymph nodes or abdomen. But this scenario is fairly uncommon when doctors see PSA rising after therapy.

With a slow-rising PSA, your oncologist will track it over time and perform periodic scans to find any cancer growth. It’s not a “sit back and watch” approach. Rather, with active surveillance, the doctor looks at very precise measurements over time to monitor changes.

For most patients, checks happen every two to three months. But all treatment plans are individualized to the patient’s case and comfort level.

When your doctor is ready to treat a high PSA, the first intervention is typically Lupron, a drug that lowers testosterone levels, which cancer feeds on.

There are two possible ways to take Lupron: intermittently or continuously. The data shows that continuous Lupron is slightly better than intermittent Lupron, but the side effects are more significant. The best course of action is to individualize.

Individualized treatment plans are the most important aspect of cancer care, as our understanding of cancer has advanced and the treatments have become more focused on specific abnormalities.

Chemotherapy is rarely the first option, even when a large mass is found. There are now a multitude of options before chemotherapy is recommended. Hormonal medicines are more specific in the enzymes they target, which means fewer side effects and a more effective treatment. There are also new medicines and molecular drugs that target specific proteins that cancer cells rely on to grow.

Before you make a decision, we recommend that you seek several opinions and review your options. We are here to help you learn the facts, know your options and choose what’s best — for you.

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