Prostate cancer recurrence

Survival Rates

Most people who have a prostate cancer recurrence have a biochemical recurrence at first. This means the PSA is rising, but imaging tests don't show any cancer yet. It can feel distressing to know the cancer is back, and you might wonder what it means for your future.

A biochemical recurrence raises the risk that the prostate cancer may spread or lead to death, but it doesn't make these outcomes certain. When metastases happen after a biochemical recurrence, they happen 7 to 8 years later, on average. One study followed people with a biochemical recurrence after prostatectomy and found the point at which half the people died of prostate cancer was more than 16 years later. Many people live for years after a prostate cancer recurrence.

If the cancer spreads to another part of the body, it may be harder to manage. The risk of metastatic prostate cancer is higher in those who have:

• A PSA level that's going up quickly. Healthcare professionals often measure the PSA doubling time in those with a prostate cancer recurrence. This is the time it takes for the PSA level to double. When the doubling time is less than 12 months, this is a sign of a higher risk.
• A higher Gleason score when first diagnosed. A Gleason score is a number that tells the healthcare team how different the cancer cells look from healthy prostate cells. Those who had a Gleason score of 8 to 10 when they were first diagnosed with prostate cancer have a higher risk than those with a lower score.
• A higher PSA level at the time of recurrence. In those treated with prostatectomy, a PSA above 0.5 nanograms per milliliter (ng/mL) is a sign of a higher risk.
• A shorter time since treatment. In those treated with radiation therapy, having a recurrence within 18 months of treatment raises the risk.

When cancer spreads, many treatments can help control it. But metastatic prostate cancer often can't be cured. The five-year survival rate for cancer that spreads is about 38%. This means that for every 100 people with metastatic prostate cancer, about 38 can expect to be living five years after diagnosis.

This survival rate comes from studying people who were treated for prostate cancer more than five years ago. They may not have had access to the latest treatments that are helping people with metastatic prostate cancer live longer. Clinical trials are testing many new treatments and new ways of using existing treatment.

Talk with your healthcare team about your prognosis and what factors may affect your personal outlook.