Risk of Prostate Cancer Recurrence

About 192,280 American men will have prostate cancer this year, making it the most frequently diagnosed cancer for men. Each man with this cancer will face a different risk of recurrence, or the chance that cancer will return after treatment. His risk depends on the type of cancer, the treatment he had and how long ago treatment occurred. Patients can talk to their doctors about the risk. Whatever your doctor says, every patient's situation is different.

Survival statistics

• Prostate cancer may return in the tissue near the gland or in the seminal vesicles, the two small sacs nearby that hold semen. Cancer may spread to surrounding lymph nodes in the pelvis or other areas of the body. The spread, or metastasis, can also recur in bones and other organs.
  In 90 percent of all prostate cancer patients, the cancer is found in the prostate alone or has spread only to the area near the gland. Early detection, usually done with a PSA-level blood test, may have improved the survival rate in the last 20 years. The American Cancer Society says about 93 percent of all men with this cancer live at least 10 years after treatment, and 77 percent survive 15 years.
  Even when the cancer has metastasized to distant tissues, about 34 percent of patients will live at least five years after diagnosis.

Risk depends on four factors

• Risk factors for recurrence include cancer cells spreading to the lymph nodes of the pelvic area, larger tumors, a higher Gleason score based on biopsy results, and the stage of the cancer.

Grading the cancer

• During a biopsy or surgery, a pathologist will examine the cancer cells to determine what grade they are, or the Gleason score. This grade applies to the cancer's appearance and assesses how quickly it's growing. The Gleason score ranges from one to five, depending on how the cancerous cells look compared with normal prostate cells.
  In grade one, the cancer tissue appears similar to normal prostate cells. In grades two to four, some cells look similar to normal cells, but others don't. Cell patterns will vary. For grade five, most of the cells do not appear similar to normal cells, and they seem to be scattered haphazardly in the gland.
  If prostate cancer returns, most men will receive hormone therapy, radiation treatment or chemotherapy. A vaccine to boost the immune system and prevent recurrence is being tested in clinical trials as of fall, 2009, but isn't ready for use in the U.S.

Follow-up exams

• After treatment, you should visit the doctor for check-ups, to make sure the cancer doesn't return or spread. Your doctor will create a follow-up plan of scheduled doctor visits, PSA tests and digital rectal exams. These will probably start a few months after completing your treatment.
  Many doctors recommend PSA tests every six months for the first five years after treatment, and at least yearly afterward. The doctor may also suggest bone scans or other imaging tests.

Recommended tests

• Because early prostate cancer usually has no symptoms, the American Cancer Society suggests that doctors discuss the possible benefits and disadvantages of prostate cancer tests, such as the PSA blood test, with all men who are 50 and older. The PSA test reveals the amount of a protein made by the prostate, or prostate-specific antigen.
  The other test for prostate cancer is the annual digital rectal exam, starting when a man turns 50, if he has an average risk for prostate cancer, does not have any major illnesses and is expected to live at least 10 more years.