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Sometimes after prostate cancer treatment, the prostate cancer may come back (recur) or progress (grow further despite treatment). Other content on this site discusses biochemical recurrence (PSA coming back) after initial treatment with surgery or radiotherapy. Here, we will focus on what it means when prostate cancer progresses despite systemic treatments, such as androgen deprivation therapy, chemotherapy, or novel hormonal therapies.

Hearing that the treatment you are receiving is no longer working and that your prostate cancer has progressed may be devastating. Many of your feelings and emotions may be similar to how you felt when you were first diagnosed with prostate cancer. These feelings may include any of the five stages of grief (which may occur in any order):

  1. Denial – feeling numb and carrying on for a period of time as if nothing has happened
  2. Anger – towards oneself or others
  3. Bargaining – making deals with oneself, or perhaps with God, that if one acts in a particular way, everything will be fine
  4. Depression – feeling sad and/or hopeless
  5. Acceptance – gradually, over time, there is usually an acceptance of the prostate cancer progression

First, during this time it is important to surround yourself with your support system. This means all the people (family, friends, co-workers, support group members, etc.) that you lean on and trust during your prostate cancer journey. Second, it is important that your doctor explains what your cancer progression means. This often involves one of the three following scenarios in the advanced prostate cancer setting:

  1. The PSA blood test is going up
  2. The prostate cancer is showing new spots (metastatic lesions) on imaging (i.e., CT, MRI, bone, PSMA PET/CT scan)
  3. Both of the above

Additionally, worse pain (particularly bone pain) may be a sign that the prostate cancer has progressed. This may be associated with any of the three scenarios above.

A Spouse's

Questions to Ask When Your Prostate Cancer Has Progressed

Much like when you were first diagnosed with prostate cancer, it is crucial to gather information and understand what questions to ask your cancer doctor and the health care team. Conversations between doctors and patients when prostate cancer has progressed are not easy (for the patient and also for the doctor). It is important to be honest with each other. Hopefully, at this point in the prostate cancer journey, you have an excellent relationship with your cancer doctor. Tell them how you feel! It’s okay to be angry, frustrated, sad, etc. These are normal feelings in these situations and your doctor understands that you are going to feel these emotions. Here are several questions you may want to ask when learning that your prostate cancer has progressed:

  1. Why did my prostate cancer progress?
  2. Do I need any other tests at this point in time?
  3. Did the stage of my cancer change?
  4. What does this mean for my future health?
  5. What treatment options can I try?
  6. Are there any clinical trials I could try?
  7. Is there someone I can talk with about my worries and anxiety?
  8. Are there other patients like me that I can talk with who have been through prostate cancer progression?
  9. If I do not want further treatment, how can I focus on supporting my quality of life?

Considering Next Treatment Options

If your prostate cancer has progressed, rest assured that there are likely many options for next lines of therapy. In advanced prostate cancer treatment, there is no “one size fits all” for deciding the next best treatment option. Appropriate treatment options for you will depend on several factors:

  1. Your prostate cancer disease state (Non-metastatic hormone-sensitive prostate cancer? Non-metastatic castration-resistant prostate cancer? Metastatic hormone-sensitive prostate cancer? Metastatic castration-resistant prostate cancer?)
  2. The treatments you have already received (both in the localized and advanced prostate cancer disease states)
  3. Your age and overall health
  4. The genetics of your prostate cancer
  5. Your goals for further treatment

Furthermore, this may be a time when you may consider enrolling in a clinical trial.

Hearing that his prostate cancer has progressed is something no man wants to hear from his cancer doctor. However, in the advanced prostate cancer setting, there are usually many more treatment options available! It is important to lean on your support team during this time, gather information, and understand the options that are available to you.

Zachary Klaassen, MD, MSc
Urologic Oncologist, Georgia Cancer Center, Augusta University, Augusta, GA, USA