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Treating Prostate Cancer: Will It Come Back?

If you work with prostate cancer patients, you’re probably familiar with the fear and anxiety they face.  Understandably, they want to know how serious their condition is and whether their cancer has metastasized.  What stage is their cancer in?  And, if treatment is successful, what is the likelihood that the cancer will recur? 

The last two questions can be difficult to answer.  And a recent study published in the November 22 online edition of Cancer, a peer-reviewed journal of the American Cancer Society, tells us stage and recurrence aren’t necessarily linked, at least not in men who have localized cancer (confined to the prostate) and who have had their prostates removed.

The study was conducted by researchers at the University of California at San Francisco.  Lead by Adam Reese, MD, the team studied data from 3,875 men with localized prostate cancer between 1995 and 2008.  “Localized” means that the cancer had not spread beyond the prostate.  The men also had their prostate glands removed in a procedure called a prostatectomy.

After analyzing the men’s data, the researchers concluded that the stage of cancer didn’t reliably predict whether cancer would come back. 

Typically, staging information is used to determine where a patient stands with an illness and whether the cancer is likely to recur after treatment.  

In the United States, prostate cancer is generally categorized into four stages.

  • Stage 1 - The cancer is located only in the prostate and the cells are microscopic.  Cancer at this stage can’t be discovered by a doctor’s digital rectal exam (DRE).

  • Stage 2 – The cancer remains within the prostate, but it has spread.  At this stage, doctors can detect the cancer with a DRE.

  • Stage 3 – The cancer has spread beyond the prostate to nearby tissues, but hasn’t reached the lymph nodes or other parts of the body.

  • Stage 4 – The cancer has spread to the lymph nodes and/or other areas, like the bladder or rectum.

It has been thought that patients in higher stages would be more likely to see recurrence, but, as this study shows, this isn’t always the case.

The University of California research team also discovered that 35.4% of the men had been staged incorrectly to begin with.  The main reasons for the staging errors were using biopsy results inappropriately and failing to consider transrectal ultrasound results. 

However, even when the researchers corrected these errors and staged the study subjects properly, the results were the same.  There was still no apparent link between stage of prostate cancer and the likelihood of recurrence.

Your patients may feel a bit unsettled by this news.  They might wonder what the point of staging is when it can’t tell them about their prognosis with any certainty.  They might also be concerned about proper staging.  What if their own doctors are misinterpreting or misapplying test data?  Could their cancer be in a different stage?  If their doctors are incorrect about their stage, what other mistakes could they be making?  And if they suspect that errors have been made, what should they do?

It’s important to remember that these study results applied only to a group of men who had been diagnosed with localized cancer and had had their prostate glands removed.  If your patients do not meet these criteria (for example, if their cancer has metastasized), the information does not necessarily apply to them.  

Your patients should feel free to discuss any questions or concerns with their doctors.   You can help them feel more comfortable doing so by reassuring them that their health care team is looking out for them and has their best interests at heart.