When Are You Considered to Have A Prostate Cancer Recurrence?
No matter how many years may have passed since your primary treatment (surgery, radiation, HIFU, etc.) for prostate cancer, if your PSA begins to rise, or if your PSA never became very low following primary treatment, you have Reoccurring (advanced) prostate cancer. This means that your cancer has returned, or was never brought under control.
The medical profession has very specific definitions as to when you have experienced a prostate cancer recurrence.
If your primary treatment was any type of radiation, including electron beam radiotherapy (EBRT, IMRT, IGRT), proton beam radiotherapy (PBRT), brachytherapy (including HDR brachytherapy) you are considered to have Reoccurring prostate cancer IF:
• You experience three (3) consecutive rises in your PSA score after having reached your nadir* score. (This is the “ASTRO [American Society for Radiation Oncology] definition.”)
• After you have reached your nadir* score, and your PSA increases by 2.0 over any period. Example: If your nadir* is 1.2, after which your PSA rises to 3.2 or more, you have experienced a recurrence. (This is the “PHOENIX definition.”)
*Nadir score is defined as your lowest PSA achieved after completing radiation. Be aware that it may take a fairly long time for radiation to achieve its full effectiveness, sometimes as long as 18 months, to reach a stable PSA nadir. Generally, the longer it takes for your PSA to reach its nadir, the greater the likelihood you will experience prostate cancer recurrence. (Citation: Cancer, 2009 March 1; 115(5): 981-987, Time to PSA nadir independently predicts overall survival in metastatic hormone sensitive prostate cancer patients treated with androgen deprivation therapy; Toni K. Choueiri etal).
After receiving radiation treatment, it is entirely normal for some men to experience a “PSA bounce” or jump for a short period of time. Don’t panic if this happens to you; it has no significance for your long-term health outlook.
If your primary treatment was any type of surgery (open, laparoscopic, robotic-assisted) you are considered to have Reoccurring prostate cancer IF:
• Your PSA rises above 0.2 and continues to increase, confirmed by at least
one additional PSA score above the 0.2 threshold. (This is the “AUA [American Urological Association] definition.”)
The most desirable PSA score after radical prostatectomy surgery is: “undetectable,” usually shown in lab results as “<0.01” or “<0.015” CAUTION- From a post on the advanced prostate cancer blog: (http://advancedprostatecancer.net/?p=1900) warns about common medications that alter PSA levels and interfere with your ability to accurately monitor your PSA for a recurrence. These include NSAIDS, 5 AR-Inhibitors, statins, and thiazide diuretics—all of which are capable of reducing PSA score by clinically relevant amounts. The specific impact of these drugs on monitoring PSA levels in unknown. (Citation: J Clin Oncol. 2010 Sep 1;28(25):3951-7. Epub 2010 Aug 2. PubMed Abstract, PMID: 20679596—also:"Impact of common medications on serum total prostate-specific antigen levels: analysis of the National Health and Nutrition Examination" Survey.Chang SL, Harshman LC, Presti JC Jr.) What Should I Do If My PSA Begins to Rise? First, be sure to note that in the definitions already cited, several PSA tests taken over a period of time are required to confirm a recurrence. A single PSA rise does not define recurrence. Your next step would likely be a series of scans to determine if you have developed any identifiable metastases (new tumors large enough to be detected by current technology). These scans can include: a bone scan, an MRI, a PET scan and a CT scan. There is a complete description of each of these scans later in this document. What is a PSA Only or Biochemical Recurrence? Some men’s scans return with negative reports, meaning there were no visible tumors, but their PSA continues to rise. This is called a PSA only recurrence or “biochemical recurrence.” Doctors refer to this as micro-metastatic prostate cancer, meaning that the growth of the cancer is too small to be seen by currently available scanning technology. All scans have limited sensitivity and can only detect what is visible above certain sizes or tolerances. Regardless of their sensitivity, scans report only the “here and now” and cannot predict what might develop in the future. However, scan technology continues to improve. A negative scan is still good news. However, just don't drop your guard by believing that the good news is durable. It isn’t.