This information is for men whose prostate cancer has come back
after treatment (recurrent prostate cancer).
Contents
What is recurrent
prostate cancer?
Recurrent prostate cancer is cancer that has come back after
having treatment such as surgery (radical prostatectomy),
radiotherapy, permanent seed brachytherapy or temporary
brachytherapy. These treatments aim to get rid of the prostate
cancer but cancer does sometimes come back.
Prostate cancer can come back in one or more areas. It could
be:
- in your prostate gland, if you did not have it removed by
surgery
- in the area where your prostate gland used to be (the prostate
bed) if the gland was removed by surgery
- in the area just outside your prostate gland
- in other areas of your body
Prostate cancer can spread to any part of the body but it most
commonly spreads to the bones and lymph nodes.
Ask your doctor or nurse for more details on where your cancer
is.
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How will I
know if my cancer has come back?
Your doctor will check for any signs that your cancer has come
back at your regular follow-up appointments. These signs may
include a rise in your PSA level in your
blood as well as any symptoms you are experiencing. They may also
do other tests to check if, and where, your cancer has come back -
this could include a biopsy or scans.
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Why has my cancer come back?
We do not fully understand why prostate cancer comes back, but
some possible reasons are below.
- The cancer was more advanced than your doctor originally
thought. Tests or scans you had when you were diagnosed might not
have picked up small clusters of cancer cells outside the prostate
gland. Your first treatment would have missed these cells. Over
time, the small clusters of cells may have grown large enough to be
picked up or cause symptoms.
- Small clusters of cancer cells might have been left behind in
the prostate after your first treatment. Over time, these clusters
of cells may have grown large enough to be picked up or cause
symptoms.
Your doctor cannot say for certain whether or not your cancer
will come back. They can only say how likely it is, based on how
aggressive the cancer is (measured by the Gleason score) and what stage it
had reached when you were diagnosed.
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What treatments are there for
recurrent prostate cancer?
You may hear treatment for recurrent prostate cancer called
second-line or salvage treatment. Some second-line treatments aim
to get rid of the cancer, and others aim to control it.
The treatments available to you will depend on various factors
and each will have advantages and disadvantages so take time to
think about what is best for you.
Treatments aiming to get rid of the cancer
- External beam radiotherapy
(EBRT). EBRT uses high energy X-ray beams to destroy the cancer
cells. You may have it with or without hormone therapy.
- High intensity focused
ultrasound (HIFU). HIFU uses ultrasound waves to heat and
destroy cancer cells in your prostate. It is newer than other
treatments and so we do not have as much information on how well it
works and its possible side effects.
- Cryotherapy. This uses freezing and thawing
of your prostate gland to destroy cancer cells. It is newer than
other treatments and so we do not have as much information on how
well it works and its possible side effects.
- Surgery (radical
prostatectomy). This isan operation to remove your prostate
gland and the cancer contained within it.
Treatments aiming to control the cancer
- Hormone
therapy. This helps control prostate cancer by stopping
testosterone reaching the prostate cancer cells.
Some men decide to take part in clinical trials of new treatments or
new combinations of existing treatments. If you are interested in
taking part in a clinical trial, ask your doctor if there are any
that would be suitable for you.
The timing of second-line treatment varies from man to man.
Waiting to start treatment means that you will delay any side
effects of hormone therapy, such as sexual problems, hot
flushes and fatigue.
Ask your doctor for more information about when any treatment
they offer you might start.
Watchful waiting
Watchful
waiting is an alternative to second-line treatment. It is a way
of monitoring prostate cancer that is not causing any symptoms or
problems. The aim is to monitor the cancer over the long term
because prostate cancer is often slow growing and may not cause you
any problems or symptoms in your lifetime.
If you choose watchful waiting, you will not start second-line
treatment unless you get symptoms, such as problems passing urine
or bone pain. If your prostate cancer does cause symptoms then you
are likely to be offered hormone therapy.
Side effects of second-line treatment
All treatments have side effects. The risk of side effects is
usually higher when a treatment is used as a second-line treatment
than when it is used as a first treatment.
Ask your doctor or nurse for more information about the possible
side effects from the second-line treatments they offer you. There
are ways to manage or reduce some side effects of treatments, for
example, taking medicines or making changes to your lifestyle.
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What treatments are available to
me?
It is unlikely that all of the treatments will be available to
you. Your doctor will discuss your individual diagnosis and agree
which treatment options are available to you. They will look at
several factors to decide which treatments they offer you,
including where your cancer is, your age and health, your PSA level
and other test results and what treatment you have already had.
Making a decision
Your doctor may offer you one treatment, or they may offer you a
choice of two or more treatments. They may also offer you the
option of watchful waiting.
All treatments have disadvantages, advantages and side effects
and it is important to discuss these with your doctor before
deciding on a treatment. You might also like to talk through your
options with your partner, family or friends, or you can call one
of our specialist nurses on our confidential Helpline.
What if I don't want further treatment?
Some men weigh up the advantages and disadvantages and decide
that they do not want to have second-line treatment for their
cancer. Speak to your doctor or nurse if you are thinking about not
having further treatment. You may be offered other treatments to
help relieve any symptoms you have now or develop in the
future.
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What
happens after second-line treatment?
You will have regular follow-up appointments to monitor how well
your treatment is working. Let your doctor or nurse know how you
are feeling and about any symptoms you have.
If your cancer comes back again after second-line treatment that
aimed to get rid of it, you may be offered hormone therapy to
control your cancer. Some men decide to take part in a clinical
trial of a new treatment or a new combination of existing
treatments.
The first type of hormone therapy you take may keep your cancer
under control for many months or years. However, over time, the
behaviour of your cancer cells may change and your cancer may start
to grow again. Although the cancer is no longer responding to your
original type of hormone therapy, it may still respond to other
types of hormone therapy or a combination of other treatments.
What if I develop symptoms?
Depending on the stage of your cancer, you may experience
symptoms such as pain and urinary problems. Treatment that is
helping to control your cancer may also cause side effects that
affect how you are feeling. Tell your doctor or nurse about any
symptoms you have. They can give you advice and treatment to help
manage your symptoms, for example, pain-relieving medicines. If you
have symptoms between your check-ups, try to tell your doctor or
nurse as soon as possible.
If your prostate cancer has spread to your bones, you may
experience symptoms such as backache or bone pain. In this case,
you may be offered pain-relieving treatments such as bisphosphonates and palliative
radiotherapy.
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Coping with recurrent prostate
cancer
It can be hard to find out that your cancer has come back. You
may have thought your cancer had gone forever and life was starting
to get back to normal. All the emotions you had when you were first
diagnosed can resurface and they may be even stronger the second
time round.
You may feel tired at the thought of having more treatment, and
you may feel less hopeful than you did before. However, many men
have successful treatment for recurrent prostate cancer.
It is normal to experience low moods when your cancer comes
back. There is no right or wrong way to deal with your feelings.
Try to go easy on yourself and do not expect to have all the
answers. You have been through a difficult time before, and you may
have learned lots of things along the way that helped you to
cope.
You may find it helpful to get some emotional and practical
support. There are a number of ways to do this.
- Talking to people close to you, such as friends and family, can
help them to support you.
- Some people find it easier to talk to someone they do not know.
Your doctor may be able to refer you to a counsellor or you can see
a private counsellor. Counsellors are trained to listen and
can help you to understand your feelings and find your own
answers.
- Some people find that it helps to talk to other men with
prostate cancer. There are prostate cancer support groups
throughout the country. You can ask your doctor or nurse for
details.
- Some men may find it helpful to talk to a faith leader or
spiritual adviser. You may wish to speak to a hospital chaplain,
who can be contacted through your doctor or nurse.
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