Treatment if your prostate cancer comes back

Your prostate cancer might come back after having treatment to try to cure it (radical or curative treatment). If this happens, it is called recurrent or relapsed prostate cancer.

Your prostate cancer can come back:

• within the prostate gland if you haven’t had surgery to remove your prostate

• in the area where the prostate was, if you have had surgery to remove your prostate

• in the area just outside the prostate

Or it can spread to other parts of the body. This is metastatic or advanced prostate cancer. 

It can be difficult to find out that your cancer has come back. Knowing what to expect and the treatment you might have can help you cope better.

How your doctor monitors you after radical treatment

After radical treatment such as surgery or radiotherapy, you have regular follow up appointments. During the appointments, your doctor asks how you are feeling and you usually have blood tests to check the levels of prostate specific antigen (PSA). They check to see if your PSA level rises and how quickly it rises.

An increase in PSA can mean there are prostate cancer cells in your body. You might need treatment if your PSA level rises.

An increased PSA level

A biochemical relapse is when your PSA level rises to a certain level after having treatment that aims to cure your cancer.

You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly to see if your PSA continues to rise quickly or stabilises. You might have a bone scan if doctors think that your cancer might have spread to other parts of the body.

Treatment options for recurrent prostate cancer

The choice about whether to have treatment and what treatment to have will depend on:

• the treatment you have already had
• your general health
• where your cancer is
• if it has spread to other parts of your body

Treatment after surgery to remove your prostate (prostatectomy)

PSA levels are usually extremely low (below the normal range) about a month after surgery. You may hear your doctor saying that your PSA level is undetectable.

Your doctor will monitor your PSA levels and if it starts to rise, you may need further treatment. This is often described as a PSA level after surgery of 0.1 ng/mL or more but this can vary. 

Your doctor might recommend:

• radiotherapy
• hormone therapy

Treatment after external beam radiotherapy

PSA levels usually get lower slowly over months or years after radiotherapy. So it can be difficult to tell when the cancer starts to grow again. Usually, doctors look for the following signs of recurrence:

• a level of 2 ng/ml above the lowest PSA level after treatment. The lowest PSA level is usually called the nadir
• 3 PSA level increases in a row (consecutive increases)

You should ask your cancer specialist if you aren’t sure about this. Your treatment options may be:

• surgery to remove your prostate gland (prostatectomy) if you haven’t had it
• hormone therapy
• a type of internal radiotherapy called temporary brachytherapy

Treatment after brachytherapy

PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the nadir is taken as a sign of recurrence.

Treatment after hormone therapy

The PSA can rise after you start hormone therapy. It may then become stable or static. If it rises again, this may suggest the cancer is becoming resistant to the hormone treatment.

If hormone therapy is no longer controlling your cancer, your doctor may suggest a different type of hormone therapy. This can be:

• abiraterone (Zytiga)
• enzalutamide (Xtandi)
• darolutamide (Nubeqa)

Other forms of treatment such as chemotherapy may also be used. You usually have the chemotherapy drug docetaxel or cabazitaxel. 

If your prostate cancer has spread

If prostate cancer has spread to other parts of your body it can’t be cured. This is metastatic or advanced prostate cancer. Treatment can help to control the cancer and your symptoms. This might be:

• hormone therapy to lower your testosterone levels
• bisphosphonates to help with bone pain
• radiotherapy to certain parts of your body such as the bones
• radioactive liquid treatment such as radium-223

If hormone therapy is no longer working for you, you might have:

• chemotherapy
• steroid tablets such as dexamethasone

Emotional support

Finding out that cancer has come back or spread can be a big shock. It might help to talk to a close friend or relative about how you feel.

Research

Clinical trials research aims to improve treatment, by making existing treatment better and developing new treatments. Your doctor might ask if you are willing to take part in a trial.