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What happens if PSA comes back after surgery?

After surgery to remove your prostate (prostatectomy) If your PSA level starts to rise, this might mean the cancer has come back. Your doctor might recommend: radiotherapy to where the prostate was. hormone treatment.

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Treatment if your prostate cancer comes back

Your cancer might come back after having treatment to try to cure it (radical or curative). Find out what your treatment options are if this happens.

How your doctor monitors you after treatment

After treatment you have follow up appointments, which usually include regular blood tests to check the levels of a protein called prostate specific antigen (PSA). They check to see if your PSA level rises. And they also look at how quickly it rises. An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in or around the prostate. Or they might have spread to other parts of your body. You might need treatment if it rises.

Prostate cancer that comes back after treatment is called recurrent prostate cancer.

An increased PSA level

A biochemical relapse is when your PSA level rises after having treatment that aims to cure your cancer. You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA rises quickly or stabilises. You might have a scan if your PSA rises quickly. The choice about whether to have treatment and what treatment to have will depend on:

the treatment you have already had

your general health

where your cancer is

if it has spread to other parts of your body

Treatment options after recurrence

After surgery to remove your prostate (prostatectomy)

PSA levels are usually extremely low (below the normal range) about a month after surgery. You may hear your doctor saying that your PSA level is undetectable (< 0.01 ng/ml). If your PSA level starts to rise, this might mean the cancer has come back.

Your doctor might recommend:

radiotherapy to where the prostate was

hormone treatment

After external beam radiotherapy

PSA levels usually get lower slowly over months or years. Saying at what level your PSA should be for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment (the nadir) is taken as a sign of recurrence, or 3 increases in a row (consecutive increases).

Your treatment options may be:

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surgery to remove your prostate (prostatectomy)

hormone treatment

cryotherapy

high frequency ultrasound (HIFU)

After brachytherapy

PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment (the nadir) is taken as a sign of recurrence.

After hormone treatment

If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static. If it rises this may suggest the cancer is becoming resistant to the hormone treatment. If hormone treatment is no longer controlling your cancer, your doctor may suggest:

abiraterone (Zytiga)

enzalutamide (Xtandi)

Newer forms of treatment such as chemotherapy may also be used.

If your prostate cancer has spread

If cancer has spread to other parts of your body it can’t be cured. This is advanced prostate cancer. Treatment can help to control the cancer and your symptoms. This might be:

hormone treatment to lower your testosterone levels

bisphosphonates to help with bone pain

radiotherapy to particular parts of the skeleton

radioactive liquid treatment radiotherapy (nuclear medicine), such as radium-223

If hormone therapy is no longer working for you, you might have:

chemotherapy

steroid tablets (such as dexamethasone)

Emotional support

Finding out that cancer has come back or spread can be a big shock. It might help to talk to a close friend or relative about how you feel.

Research

Clinical trials research aims to improve treatment, by making existing treatment better and developing new treatments. Your doctor might ask if you are willing to take part in a trial.

cancerresearchuk.org - Treatment if your prostate cancer comes back

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