Health
Managing Recurring Prostate Cancer After PSA Rise
Health Points
- PSMA scans reveal small tumors unseen by traditional imaging, offering new insight after a PSA rise.
- Immediate aggressive treatment isn’t always necessary; expert guidance supports monitoring for many men.
- Personal health, cancer aggression, PSA trends, number of tumors, and patient goals drive decision-making.
After surgery or radiation for prostate cancer, some men see their PSA levels start to climb, signaling a biochemical recurrence even before scans detect any cancer.
Emerging PSMA scanning technology can spot tiny tumors traditional scans miss, introducing a new layer of complexity to treatment choices.
Doctors are now using the term (PSMA) + BCR to describe cases where PSMA scans show cancer recurrences too small for conventional imaging to detect.
Treatment approaches differ: doctors may choose to monitor these cases, especially when PSA is rising slowly, or start hormone-blocking therapies if risk factors are high.
“We’ve encountered situations where patients have small cancerous lesions on a PSMA scan that don’t necessarily grow,” says Dr. David Einstein, leader at Beth Israel Deaconess Medical Center.
In some cases, rapidly starting powerful treatments adds only side effects, while monitoring may provide similar survival outcomes with a better quality of life.
“Many, if not most, men” with PSMA-detected recurrence face “no imminent threat of morbidity or mortality from their prostate cancer,” Dr. Einstein explains.
Factors influencing decisions include overall health, cancer aggressiveness, PSA doubling time, the number of tumors, and an individual’s values and life goals.
Research is ongoing to better understand how PSMA-detected recurrences behave and to develop targeted therapies that may reduce long-term side effects.
“The advanced technology of PSMA scanning that detects very small deposits of cancer has raised important treatment questions that are now being actively studied,” says Dr. Marc B. Garnick, editor in chief of the Harvard Medical School Guide to Prostate Diseases.
He adds, “Delaying or postponing treatments that would in the past have been given immediately is a strategy that is often embraced by our patients.”
Regular consultations with your healthcare team ensure your treatment approach fits your health status, cancer trends, and life preferences.
