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Stephan L. Werner, M.D. F.A.C.S. Prostate cancer requires lifelong follow-up! Unfortunately, prostate cancer can recur many years after apparently successful treatment. There have been recurrences after 10 to 15 years, so a patient who has had prostate cancer must get regular checkups throughout their life. There are two different sites of recurrence, locally in the prostate bed, and metastatic to other areas. A prostate cancer follow-up visit will include a review of your symptoms such as changes in voiding patterns, bleeding, weight loss and bone pain. A digital rectal exam, DRE, will be performed to determine if there are any changes in the prostate or prostate bed, and a PSA obtained to see if there are any increases that should be investigated. In general, when there are no signs of recurrence, follow-ups should be every 3 months for 1 to 3 years, every six months for several years, and after 5 years no less than once a year. Factors such as Gleason Grade, extensiveness of the cancer, and whether is was confined to the prostate will determine the frequency of follow up. After radical prostatectomy the PSA should drop to less than 0.1. Failure to drop to this level is cause for concern and further evaluation or treatment may be necessary. Similarly, if there is recurrence of a nodule in the surgical site further evaluation will be necessary. After radiation, either seeds, (brachytherapy), or external beam or cryotherapy the PSA will drop slowly, frequently reaching its nadir after several years. It is not uncommon to see a "bounce" in the first several years lasting several months, and then continuing to decline. PSA levels should drop below 1 and stay there. Digital rectal exams are also necessary. After cryotherapy levels should slowly drop below 1 and stay there. After radical prostatectomy, If the PSA rises or the DRE tells the urologist there are any changes in the surgical site further evaluation is required. Not all rises in PSA or changes in the DRE are recurrent cancer, there might be regrowth of a small amount of normal prostate tissue, but this must be proven. If there is a slight rise in PSA, a repeat blood test in several weeks or months may be appropriate, especially if there is a low probability of recurrence. That is if the Gleason grade was less than 7, the PSA before surgery was less than 10, and the cancer was confined to the prostate at surgery. Otherwise, a sonogram and biopsy, and a bone scan, or possibly a Prostascint scan may be required. In patients who had positive margins at surgery, a biopsy may not be needed before secondary therapy is started. When the cancer recurs only in the prostate bed, a secondary cure with radiation or cryotherapy may be achieved in some patients. Others will develop progressive disease. If the only sign of recurrence is a rising PSA, without any detectable disease, some physicians will recommend local radiation, others hormonal therapy, and others will observe it until the site of recurrence is obvious. However, there is now data available (2001) that early addition of hormonal therapy to whatever local therapy is given may significantly increase life expectancy. There is no one correct answer, and the treatment decision will lie with the doctor and the patient. If the recurrence is a distant metastasis, (spread), most commonly to the bones, hormone therapy is frequently started. After Radiation, a continuing rise in PSA over 1.0 or recurrence of a nodule in the prostate will require a search for the site of recurrence. Biopsy, bone scan, prostascint scan of CT or MRI may be used. If the recurrence is localized to the prostate several options are available. Secondary surgery or salvage prostatectomy may be performed. The procedure is difficult and the complication rate is high. If brachytherapy, (seeds) was the primary, some physicians will use secondary 3-D, conformal external beam radiation. Cryotherapy is also a valid secondary treatment after either external beam or brachytherapy. Hormonal therapy is frequently instituted, and current data suggests that it may significantly improve long term survival when added to other secondary therapy. If the recurrence is distant from the prostate, (metastasis), hormonal therapy is usually given. After Cryotherapy a continuing rise in PSA over 1.0 or recurrence of a nodule in the prostate will require a search for the site of recurrence. Biopsy, bone scan, prostascint scan or CT or MRI may be used. There is not much data available on secondary prostatectomy or radiation treatment after cryotherapy, Repeat cryotherapy is possible. Hormonal therapy is frequently instituted, and current data suggests that it may significantly improve long term survival when added to other secondary therapy. If the recurrence is distant from the prostate, (metastasis), hormonal therapy is usually given. Stephan Werner, M.D., F.A.C.S. Rev: 09/04 |
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[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
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