After being diagnosed with prostate cancer, men and their loved ones have decisions to consider about treatment. When thinking about your options, it’s important to know that no treatment can guarantee that prostate cancer will never come back.
In many cases, the chance of the cancer returning depends more on the cancer itself than on the treatment you choose.
Factors that affect the risk of recurrence include:
- Your PSA (prostate-specific antigen) level before treatment
- How abnormal the cells are (Gleason score or Grade Group)
- If the cancer has spread (stage)
- If cancer cells were found at the edge of the tissue removed during surgery (positive surgical margin)
Checking PSA After Treatment
After treatment is a period of follow-up care. Some men need additional treatment after surgery or radiation. This is called adjuvant therapy (right after primary therapy – typically radiation after primary surgery) or early salvage therapy (after a PSA increase after the primary therapy). However, many men simply have regular checkups to monitor their recovery and watch for any signs that the cancer has returned.
Regular PSA testing is one of the most important ways to monitor for prostate cancer after treatment. One common follow-up timeline after surgery or radiation is: a PSA check every 3 months for the first 1-2 years, followed by every 6 months for 2-3 years, followed by annual PSA checks thereafter. Of note, this follow-up plan may vary based on PSA levels, prostate cancer aggressiveness, and health care provider preference.
A rising PSA level is often the earliest sign that prostate cancer has returned. In many cases, the PSA begins to rise long before the cancer can be seen on a CT scan, MRI, or PSMA PET/CT scan.
Finding a recurrence early may allow treatment to begin sooner if it’s needed.
It's Normal to Worry About the Cancer Coming Back
Many men feel anxious before follow-up appointments or while waiting for PSA test results.Research suggests that about 1 in 3 men have a high level of fear that their prostate cancer will return.
Fear of recurrence may be more common in:
- Younger men
- Men with a higher risk of recurrence
- Men with higher levels of anxiety
For most people, these worries become less intense over time. However, 5-10% of men continue to have a lot of fear more than 10 years after treatment, even when there is no sign that the cancer has returned.
If you are struggling with anxiety or fear of recurrence, remember that you are not alone.
It may help to:
- Talk openly with your healthcare team.
- Share your concerns with your partner, family, or close friends.
- Connect with other men who have had prostate cancer by going to a support group.
- Ask about counseling or mental health services if worry is affecting your daily life.
If Your PSA Begins to Rise
A rising PSA after treatment is called a biochemical recurrence. This does not always mean you need treatment right away. Biochemical recurrence has different definitions based on what your primary treatment was:
- After surgery: PSA ≥0.2 ng/mL, confirmed by a second PSA ≥0.2 ng/mL
- After radiation: PSA rise ≥2.0 ng/mL above the post-radiation PSA nadir (the lowest level the PSA reached after radiation before it started increasing)
There are several treatment options for biochemical recurrence after surgery or radiation, which should be discussed with your health care team
If You Worry About Other Types of Cancer
Some men also worry about developing other types of cancer.For most men with prostate cancer, the risk of developing another type of cancer is similar to that of the general population.
However, some inherited gene changes that increase the risk of prostate cancer can also increase the risk of other cancers. You can talk with your healthcare provider about gene testing (also called germline testing) to see if you are at genetically at risk of other cancers.
Additionally, men who have been treated with radiation therapy have a 10-year risk of 2-4% for developing bladder cancer and a 1-1.5% risk of developing rectal cancer. Any blood in the urine or stool should immediately be reported to your health care team.
Follow-Up Care is Important
Regular medical care is important after prostate cancer treatment.
Be sure to:
- Keep all recommended follow-up appointments.
- Have PSA tests as advised by your healthcare provider.
- Stay up-to-date with recommended cancer screening tests, such as colorectal cancer screening.
- Tell your healthcare provider about any new or concerning symptoms, such as blood in your urine, ongoing pain, or unexplained weight loss.