Can Delaying Treatment For Prostate Cancer Increase Your Relapse Risk?


As the second leading cause of cancer-related deaths in men, prostate cancer is also the third most common cancer in the U.S. after breast and lung. There have been approximately 165,000 new cases and 29,000 new deaths reported in 2018, but there is a silver lining. 98 percent of men survive five or more years after being diagnosed, and the percentage of new cases and deaths has been falling in recent years.


Cancer of the prostate occurs when mutated cells in the prostate gland start to multiply at an uncontrollable rate and grow into a tumor. The condition only affects men over 40, although there have been rare occurrences of prostate cancer in men under 40. As with any form of cancer, the exact causes are unknown and there is currently no “cure,” but catching this disease early can leave you with very promising treatment options.


What are the Risk Factors and Symptoms?


Scientists have been trying to understand mutations in DNA for decades. Although we may not understand exactly what causes prostate cancer, we can conclude that DNA-controlling genes, such as oncogenes and tumor suppressor genes, play a large role in cancer development. While more research is required, inactivation of tumor suppressor genes is thought to be largely responsible for the advancement of prostate cancer. A person can inherit a genetic mutation, known as hereditary prostate cancer, or they can acquire a genetic mutation through cancer-causing chemicals, for example. A family history of prostate cancer greatly increases one’s risk of developing the disease later in life.


There are several non-mutation related risk factors that can contribute to the development of prostate cancer as well. A man is at an increased risk for prostate cancer if he:


  • Is over 60
  • Is African American
  • Lives in North America, Australia or Europe
  • Has been exposed to Agent Orange


Most cases of prostate cancer do not show any symptoms in the early stages, which makes it even more important to get regular checkups with a doctor after age 40. In the later stages, some visible symptoms to watch out for include:


  • Excessive weight loss
  • Pelvic, hip, belly, or lower back pain
  • Blood in urine
  • Trouble urinating / painful urination
  • Fatigue
  • Erectile dysfunction


Prostate Cancer Stages and Treatments


Determining the stage of your prostate cancer is the best (but not the only) way to decide your treatment plan. The staging process tells your urologist how much the cancer has grown and whether or not it has spread outside the prostate. However, your doctor will still take factors such as age, overall health and personal preference into consideration when developing your treatment plan. On average, here’s briefly what you can expect from each of the following four stages:


Stage 1

At this stage, the cancer has not spread outside of the prostate and there are no visible symptoms. Elderly men with other health complications are advised to just keep an eye on the condition and check in regularly with their doctor. Younger, healthier men who wish to start treatment can look into radiation therapy or radical prostatectomy.


Stage 2

At stage 2, the cancer has not yet spread outside of the prostate but is likely to if not treated. In most cases, there are still no visible symptoms at this stage, and if you are not yet experiencing any and are advanced in age, it is recommended to monitor the situation. Treatment options for younger or healthy men include: Radical prostatectomy, external beam radiation or brachytherapy.


Stage 3

At this stage, the cancer has spread outside the prostate but has not reached the bladder, rectum, lymph nodes, or distant organs. Men at this stage have a greater risk of recurrence after treatment than previous stages. Because of this, more aggressive treatment options are recommended, such as: External beam radiation plus hormone therapy, radiation plus brachytherapy, or radical prostatectomy followed by radiation therapy.


Stage 4

At stage 4, the cancer has spread to a number of nearby areas, such as the bladder, rectum, lymph nodes, and bones. Most stage 4 cases are still treatable, and with the help of the mentioned options (as well as chemotherapy and surgery in some cases), patients are able to reduce pain symptoms and extend their lifespans.


New Study Involving Relapse Risk  


The results of a very recent study indicate a patient’s risk of reoccurrence for prostate cancer is increased if treatment is delayed more than six months. Dr. Yamoah and colleagues at H. Lee Moffitt Cancer Center analyzed the effects of using radical prostatectomy as the primary method of treatment for patients with prostate cancer. They monitored the outcomes for patients who were treated three months or less after being diagnosed, six months after their diagnoses, and those who waited longer than six months. The biochemical reoccurrence of disease did not seem to greatly increase for the first two groups, but the risk went up dramatically for patients waiting longer than six months.


“As a clinician, it was surprising that treatment delays were significantly associated with short-term outcomes like biochemical recurrence or early treatment failure, contrary to some reports in contemporary literature. In addition, we also observed that African-American men, who are at higher risk of poor PCa outcomes, were more likely to experience treatment delays,” said Dr. Yamoah. The findings from this study were so alarming to some researchers that many believe delaying treatment should be considered its own risk factor for prostate cancer.


What Does This Mean for Patients?


Not all oncologic experts agree with the results of this study and believe more research is needed on the subject. Dr. Garzotto, Professor of Urology and Radiation Medicine says, “since this is a retrospective cohort of referred patients, I would be very cautious in the interpretation of these results. In this study, we do not have any data on why patients chose to wait 6 months or longer. Patients whose treatment was delayed beyond six months made up only 7 percent of the cohort, so they appear to be a highly selected group.”


Whether the conclusion of this study is absolute or not, it is still a good idea to seek treatment for prostate cancer as soon as possible. Visit an experienced urologist today to come up with the right treatment plan for you.