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Reason for Post-Treatment Prostate Cancer Reoccurrence in Some Men After Hospital Discharge

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If your prostate-specific antigen (PSA) blood level shows that your prostate cancer has not been cured or has come back (recurred) after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment(s) you've already had

Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.

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“Am I going to die?” This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen (PSA) level has risen after he has already undergone treatment for prostate cancer (usually a radical prostatectomy or radiation therapy)

The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan. That’s usually of small comfort to the patient whose PSA has risen. It’s emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, it’s as if they’re dealing with another diagnosis of cancer, except this time it’s much worse because there is less likelihood of getting cured. A man’s confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly. Which brings me back to my patient’s question: “Am I going to die?” The simple answer is yes, eventually — we all do — but you may not die from prostate cancer. Of course, with prostate cancer, nothing is simple. This may be one disease, but it can appear in multiple forms, so every diagnosis or recurrence requires individualized assessment and intervention. To start thinking about the salient issues, see “Four key questions.”

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However, few studies focus on adherence to PSA surveillance following radiation therapy. Posttreatment surveillance among surgical patients is generally high, but sociodemographic disparities exist. Racial and ethnic minorities and unmarried men are less likely to undergo guideline concordant surveillance than is the general population, potentially preventing effective salvage therapy (Skolarus TA, 2013). A recent Department of Veterans Affairs (VA) study on posttreatment surveillance included radiation therapy patients but did not examine the impact of younger age, concurrent androgen deprivation therapy (ADT), or treatment facility (ie, diagnosed and treated at the same vs different facilities, with the latter including a separate VA facility or the community) on surveillance patterns

The latter is particularly relevant given increasing efforts to coordinate care outside the VA delivery system supported by the 2018 VA Maintaining Systems and Strengthening Integrated Outside Networks (MISSION) Act. Furthermore, these patient, treatment, and delivery system factors may each uniquely contribute to whether patients receive guideline-recommended PSA surveillance after prostate cancer treatment. For these reasons, we conducted a study to better understand determinants of adherence to guideline-recommended PSA surveillance among veterans undergoing definitive radiation therapy with or without concurrent ADT. Our study uniquely included both elderly and non-elderly patients as well as investigated relationships between treatment at or away from the diagnosing facility. Although we found high overall levels of adherence to PSA surveillance, our findings do offer insights into determinants associated with worse adherence and provide opportunities to improve prostate cancer survivorship care after RT (Kirk PS, Borza T, 2018).

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In the long run, all treatments for prostate cancer can cause side effects

Many men get urinary problems as a side effect of their treatment. The prostate gland lies underneath the bladder and surrounds the urethra – which is the tube that carries urine from the bladder, through the penis and out of the body. So both the bladder and urethra can be damaged by treatments for prostate cancer, causing side effects.

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Kirk PS, Borza T, Shahinian VB, et al. The implications of baseline bone-health assessment at initiation of androgen-deprivation therapy for prostate cancer. BJU Int. 2018;121(4):558–564.

Baldwin LM, Andrilla CH, Porter MP, Rosenblatt RA, Patel S, Doescher MP. Treatment of early-stage prostate cancer among rural and urban patients. Cancer. 2013;119(16):3067–3075.

Skolarus TA, Chan S, Shelton JB, et al. Quality of prostate cancer care among rural men in the Veterans Health Administration. Cancer. 2013;

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