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After being diagnosed with prostate cancer, men (and their spouses and families) sort through a lot of information to decide on treatment options. They must consider many factors including cancer control, short- and long-term side effects, and the burden and costs of each treatment option. It’s important in this decision-making process to understand that no treatment approach is 100% certain to result in a prostate cancer cure. Indeed, it is often the cancer characteristics rather than the treatment approach that most strongly drives the chance of cancer recurrence. “Cancer characteristics” mean the risk group, as determined by PSA levels, cancer stage, tumor grade, and for patients who had surgery, the surgical margin.

After the very active process of deciding on a treatment choice, the time following treatment may feel a little bit passive or slow. During this time, most patients are monitored, unless there is a specific reason for a second (adjuvant) treatment to be given. Even then, following adjuvant therapy, most patients undergo a period of observation. Under observation, PSA tests are performed on a scheduled basis, between every 3 months and every year.

While there are some controversies about using PSA as a screening test before a prostate cancer diagnosis, doctors agree that PSA is a very useful test to use after prostate cancer to check for recurrence. PSA levels in the blood begin to rise as very early evidence of recurrence — before it ever could be detected on CT scans or other imaging tests. Because of this, PSA monitoring makes it possible to catch recurrence early and start salvage treatments.

During PSA monitoring, it is understandable that a man might be anxious about, or fear, his prostate cancer returning. Researchers have found that nearly one-in-three men have a high fear of recurrence. While a high fear of recurrence is associated with younger patient age and certain personality types, cancer-related details (including those that increase the risk of recurrence, such as a higher PSA at the time of diagnosis) and treatment choices were also associated with a higher fear of recurrence.

Over time, many men will find that their fear of recurrence decreases. However, a group of men (approximately 5-10%) will still continue to have a bothersome amount of fear even more than a decade after treatment, with no recurrence in the meantime. It’s important to understand that these feelings are common, and shared by other men. You may find that discussing these concerns with your doctors, your spouse and family members, or other men with prostate cancer can help to normalize them and maybe even help to lower them. Many cancer centers also have access to mental health care that may be helpful in working through these feelings.

Importantly, a number of researchers have found that patients who are more anxious about their prostate cancer, and cancer recurrence, are more likely to start hormone treatments after a PSA recurrence (biochemical recurrence). In this setting, starting hormone therapy earlier does not necessarily improve cancer management or life expectancy. However, it often results in side effects and may not be in your best interest.

Other than prostate cancer recurrence, men also may be worried about developing other cancers. For certain men with hereditary prostate cancers, caused by specific gene mutations, there may be an increased risk of specific cancers. However, for most men with prostate cancer, the risk of other cancers isn’t that much higher than it would be for the rest of the population. Men who are treated with radiotherapy have a higher chance of developing bladder or colorectal cancers, though this increase in risk is relatively small.

Men with prostate cancer should make sure that they stay up to date with other cancer screening tests — for example, getting a colonoscopy for colon cancer. Also, they should share any concerning symptoms (such as blood in the urine) with their doctors so that they get the testing they need.

Zachary Klaassen, MD, MSc
Urologic Oncologist, Georgia Cancer Center, Augusta University, Augusta, GA, USA