Options if Treatments Fail
Indications of Persistent Cancer after Initial Treatment
Rising PSA Levels. If prostate cancer has been eliminated, PSA levels should drop to 0.5 ng/mL or less after treatment. A sudden rise or persistently elevated PSA levels after treatment are often indications that prostate cancer persists:
- If PSA levels are above 2.0 ng/mL, then cancer is most likely still present.
- If PSA levels are between 0.5 and 2.0 ng/mL, the situation is less clear. One study indicated that measuring free PSA may help determine the status of the cancer in such patients. An average free PSA of 27% indicated that cancer had been eliminated, while an average of 15% meant that cancer was still present.
Note: It is common for PSA levels to temporarily rise following radiation seed implantation without signaling cancer recurrence.
General Prognosis with Recurrence or Failure
Rising PSA levels do not necessarily mean that the cancer has spread or even that the cancer will recur during a man's lifetime. An actual cure is still possible if the cancer is localized within the prostate. In one study, 64% of patients with rising PSA levels after surgery still had cancer confined to the prostate. Indications of a poorer outlook in this study included:
- Cancer penetration of the prostate capsule
- Positive surgical margins (microscopic evidence of cancer cells at the very edge of the resected specimen)
- Invasion of nearby vessels or lymph nodes
Still, among the men in the study, after 7 years only 3% of patients had died of prostate cancer. After 15 years, only 19% had evidence of recurrence. Other markers for persistent cancer are under investigation. For example blood tests that show low levels of acid phosphatase (ACP) before treatments may predict a higher chance for recurrence-free survival.
Treatment Options for Recurring or Persistent Prostate Cancer After Local Treatment
Treatment for recurring cancer is not always clear-cut. If the cancer recurs locally, cure may still be possible:
- Surgery and androgen-suppression therapy may be considered for patients who were first treated with radiation
- For patients who were initially treated with surgery, radiation or androgen-suppression therapy are both options
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