This information is for you if your prostate cancer has come back after treatment that aimed to get rid of it. This is called recurrent prostate cancer.

What is recurrent prostate cancer?

Recurrent prostate cancer is cancer that has come back after the following treatments:

All these treatments aim to get rid of the prostate cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought.

Finding out your cancer has returned

Your doctors and nurses will have monitored you after your first treatment to check for any signs that the cancer has come back.
 
Usually the first sign that your cancer is starting to return is a rise in the level of prostate specific antigen (PSA) in your blood. The PSA test is a very effective way of checking how successful your treatment has been.

The exact change in PSA level that suggests that your cancer has come back depends on which treatment you had. Your doctor may do other tests to check if, and where, your cancer has come back.

Your prostate cancer may have come back in one or more areas. It could be:

  • in your prostate gland, if it hasn’t been removed by surgery
  • in the area around where your prostate gland used to be (called the prostate bed) if the prostate has been 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 about where your cancer is or is likely to be.

Why has my cancer come back?

It’s not completely clear why prostate cancer comes back, but scientists have suggested some possible reasons. 

  • 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 by tests or to cause symptoms.
  • Not all of the cancer cells in your prostate were treated during your first treatment. Small clusters of cells might have been left behind. Over time, these may have grown large enough to be picked up by tests or to cause symptoms.

When you were diagnosed your doctor would not have been able to tell you whether or not your cancer would come back. But they may have said how likely it was. Read more about your chance of cancer coming back.

What treatments are there for recurrent prostate cancer?

Treatments for recurrent prostate cancer called second-line (or salvage) treatments. There are two main type of second-line treatment. These are:

  • treatments that aim to get rid of the cancer (curative treatments)
  • treatments that aim to control the cancer – these aim to stop the cancer growing but do not get rid of it

Treatments aiming to get rid of the cancer

  • External beam radiotherapy (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) uses ultrasound waves to heat and destroy cancer cells in your prostate. It is newer than other treatments and so we don't have as much information on how well it works and its possible side effects.
  • Cryotherapy uses freezing and thawing of your prostate gland to destroy cancer cells. Like HIFU, it's newer than other treatments and so we don't have as much information on how well it works and its possible side effects.
  • Surgery (radical prostatectomy) to remove your prostate and the cancer contained within it. This is rarely used as a second-line treatment.

Treatments aiming to control the cancer

  • Hormone therapy helps control prostate cancer by stopping testosterone reaching the prostate cancer cells, wherever they are in the body.

Some men who have recurrent prostate cancer 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.

Observing your prostate cancer

This is an alternative to having second-line treatment straight away. It’s a way of monitoring prostate cancer that is not causing any symptoms or problems at the time. The aim is to keep an eye on the cancer over the long term and delay treatment until it’s really necessary. Prostate cancer is often slow-growing and may not cause you any problems or symptoms in your lifetime.   

If your prostate cancer is being observed, you will not start second-line treatment until tests show that your cancer is growing or you start to get symptoms, such as problems urinating or bone pain.

Observing your prostate cancer involves regular PSA tests. You may also have other scans and tests. If these suggest your cancer is growing, or if you start to get symptoms, then you are likely to be offered hormone therapy to control the cancer and help relieve symptoms.

Which second-line treatments are available to me?

It’s unlikely that all of the treatments will be available to you. Speak to your doctor or nurse about which treatment options are available to you. Several factors affect which treatments are suitable, including:

  • where your cancer is
  • your general health
  • your PSA level and other test results
  • what treatment you’ve already had

When will my treatment start?

The timing of second-line treatment varies from man to man. Ask your doctor for more information about when your treatment will start.

If you’re having treatment that aims to get rid of the cancer, treatment could start straight away.
 
If you’re having treatment that aims to control the cancer (hormone therapy), when you start treatment will depend on several things, including:  

  • whether your prostate cancer has spread to other parts of your body
  • whether you have any symptoms from your cancer  
  • how quickly your PSA level is rising
  • how you feel about starting treatment

Waiting to start treatment means that you will delay any side effects of hormone therapy, such as sexual problems, hot flushes and fatigue.

Side effects of second-line treatment

The risk of side effects is usually higher when a treatment is used as a second-line treatment than when it’s used as a first treatment. Side effects may also be more severe with a second-line treatment. And you might still have side effects from your first treatment.

Our treatment pages provide information about the most common side effects of each treatment. However, this information is about first-line treatments so bear in mind that the risks of side effects may be higher if you have second-line treatment.

Ask your doctor or nurse for more information about the possible side effects from the second-line treatments they offer you. Knowing about the possible side effects can help you make a decision about your treatment.

There are things you can do to manage side effects. Read more on our pages about living with prostate cancer.

Making a decision

Your doctor might offer you one treatment, or a choice of treatments. They may also offer you the option of observing your prostate cancer.

All treatments have advantages, disadvantages and side effects. It's important to discuss these with your doctor before deciding on a treatment. You could also talk through your options with your partner, family or friends, speak to a Specialist Nurse over the phone or chat to a nurse online.

What if I don't want further treatment?

Some men weigh up the advantages and disadvantages and decide that they don't want to have second-line treatment for their cancer. Speak to your doctor or nurse if you are thinking about not having further treatment. They may suggest observing your prostate cancer with regular tests. If it starts to cause symptoms then you’re likely to be offered hormone therapy to control the cancer and help relieve symptoms. There are also other treatments to manage symptoms which you can read about below.

What happens after second-line treatment?

You will have regular follow-up appointments to monitor how well your treatment is working. The aim is to:

  • check how your cancer has responded to treatment
  • deal with any side effects of treatment  
  • give you a chance to raise any concerns or ask any questions 

You will have regular PSA tests as part of this follow up.

If your cancer comes back again after treatment that aimed to get rid of it, you will be offered hormone therapy to control your cancer, though you may not need to start it straight away.

Hormone therapy can keep your cancer under control for many months or years before you need to think about other treatments.

But over time, your cancer may start to grow again. You may continue having your original hormone therapy, but there are also other treatments available. These include other types of hormone therapy as well as chemotherapy. Read more about these on our page about second-line hormone therapy and further treatment options.

Some men decide they would like to take part in a clinical trial of a new treatment or a new combination of existing treatments.

What if I develop symptoms?

Tell your doctor or nurse about any symptoms you have. If you have symptoms between your check-ups, tell your doctor or nurse as soon as possible. If these are signs of the cancer coming back they can talk to you about treatment options.

Your doctor or nurse can also give you advice and treatment to help manage your symptoms. For example, if your cancer has spread to the bones and is causing pain, there are treatments to help, such as pain-relieving medication, drugs called bisphosphonates and pain-relieving radiotherapy.

Dealing with recurrent prostate cancer

A lot of men find it hard if they discover their cancer has come back. All the emotions you had when you were first diagnosed can resurface and they may be even stronger the second time round.

Some men feel angry that their cancer has come back. It is normal to want to find an explanation, but remember it’s not your fault – try to go easy on yourself.

The thought of more treatment can be overwhelming. You may feel less hopeful than you did before. However, men do have successful treatment for recurrent prostate cancer.

You may also have practical concerns about your cancer coming back, for example, worries about work or money.

How can I help myself?

  • Find out about recurrent prostate cancer and the treatments available to you, so you know what’s going on and what to expect.
  • Be as active as you can. Physical activity can lift your mood.
  • Think about what you eat and drink. Some men find they manage better by aiming for a healthy, balanced diet.  
  • Unload what’s going around in your head - find someone you can talk to. It could be someone close, or someone trained to listen, like a counsellor or your medical team.
  • Take time out to look after yourself. When you feel up to it, learn some techniques to manage stress and to relax – like listening to music or breathing exercises.
  • Set yourself goals and things to look forward to.
  • Find more strategies in our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues.

Some men find it helpful to get some emotional and practical support from others. There are a number of people who can offer support.

  • Talking to your partner, family and friends can help take some of the pressure off you.
  • Get in touch with your local prostate cancer support group. Support groups can be a good way for you to meet people with similar experiences.
  • Sign up to our online community, where you can share your views and experiences with others affected by prostate cancer.
  • Our One-to-one support service gives you the chance to talk with a trained volunteer who has direct experience of prostate cancer. Many people find it helpful to talk to someone who has been in a similar situation.
  • Talk to your nurse, doctor or any other health professionals you see about how you’re feeling. You can also speak to our Specialist Nurses over the phone or speak to a nurse online.
  • It’s sometimes hard to speak to those closest to you because you don’t want to upset them or show your emotions. Some people find it easier to talk to someone they don’t know – like a counsellor. Your GP can refer you or contact the British Association for Counselling & Psychotherapy.
  • Get spiritual support if you need it. This could be from your friends or family, or from your religious leader or faith community.