Advice for the Recurrent Patient

For Those Experiencing a Recurrence

What a disappointment, you went through this once and thought it would be over for you. Now, you find yourself back in the tangled environment of treatment options all over again.

First, know that you are not alone. Studies tell us that each year close to 50,000 men will develop a biochemical recurrence following initial treatment – 30,000 of these from radical prostatectomy and 13,000 from primary, single source radiation. Statistics resulting from other, newer forms of treatment (such as proton beam, HIFU, cryotherapy, Cyberknife®, Calypso, etc.) are not readily available, but will contribute to an even larger number of cases that recur. Most men are of the mindset that if they go through with a big operation and have their cancers removed, they may have to suffer the consequences of erectile dysfunction and/or impotency, but at the end of the day their prostate and cancer is gone. However, that doesn’t mean that either the gland or its cancer have been entirely removed. Even the most contemporary studies demonstrate that the majority of patients undergoing surgery will ultimately be faced with a recurrence. Radical surgery patients more often than not find themselves asking their urologist, “How could my cancer be back? Why is my PSA rising? I don’t even have a prostate!”

A surprising finding is the number of robotic prostatectomy patients that are developing recurrence within the first 3 months to 3 years following their surgeries. In 2008, a Duke University study was quoted in European Urology, saying patients who underwent robotic surgery had “significantly higher levels of dissatisfaction and regret than patients undergoing retropubic radical prostatectomy.” (Schroeck FR, et al., Eur Urol 54, 2008).

We have known and advocated for two decades that surgery is not a reasonable solution to prostate cancer because of the propensity of the disease to appear close to the gland margins and to grow aggressive microscopic fingers outside of the gland which can not be removed with the surgical scalpel.

What can you do now? By all means, don’t ignore it. It is believed that close to 3 of 4 men (75%) with recurrent prostate cancer will develop deadly bone metastasis within 10 years.

Above all else, don’t beat yourself up for the treatment choice you made originally. In the language of urology, the physician will say “you failed,” when in fact it was the treatment that failed you. You must not fault yourself for the decision you made. That was then; this is now.

Remember that there are nearly 3 million American survivors of prostate cancer, and the number grows every day.

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