What is recurrent prostate cancer?

Some treatments aim to cure prostate cancer and others aim to control it, without getting rid of it. Recurrent prostate cancer is cancer that has come back after you’ve had a treatment that aimed to cure it, such as:

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

It can be very difficult to learn that your cancer has come back. All the thoughts and feelings you had when you were first diagnosed can come back again and they may be even stronger than before.

It's normal to feel shocked, angry, frustrated, disappointed, worried or sad. Things can get easier over time but some of these feelings may stay with you. Lots of men find it helpful to talk to someone about their feelings. This might be a friend or family member or someone who is trained to listen, like a counsellor or your doctor or nurse. Or you can talk to someone who’s been there through our one-to-one support service. Read more about getting support here.

How do I know if my prostate cancer has come back?

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 continuous 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 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. These may include CT, MRI, and bone scans. Click here to read more about follow-up after treatment for prostate cancer.

Why has my cancer come back?

It’s not always completely clear why prostate cancer comes back, but there are two main possible reasons.

  • 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.
  • The cancer was more advanced than your doctor originally thought. Tests or scans you had when you were diagnosed might have missed small clusters of cancer cells outside your prostate, for example in your lymph nodes or bones (see the diagram below). Your first treatment would not have been aimed at these cells. Over time, the small clusters of cells 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.

Where could my prostate cancer come back?

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

  • in your prostate, if your prostate hasn’t been removed by surgery
  • in the area around where your prostate used to be (the prostate bed) if the prostate has been removed by surgery
  • in the area just outside your prostate
  • in other parts of your body.

 Diagram showing where prostate cancer can come back including in the prostate, the prostate bed, the lymph nodes and the bones

 

Prostate cancer can spread to any part of the body but it most commonly spreads to the bones and lymph nodes.

Prostate cancer that has spread to other parts of the body is known as advanced prostate cancer. Read more about advanced prostate cancer.

Sometimes it’s not clear where the cancer is. Some men may have a rise in their PSA level but the cancer may not show up on other tests, at least at first. This is quite common and your doctor will discuss treatment options with you.

What treatments are there for recurrent prostate cancer?

Treatments for recurrent prostate cancer are called second-line (or salvage) treatments. Many of the treatments used to treat prostate cancer when it’s first diagnosed can also be used as second-line treatments.

Making a decision about treatment

Your doctor might offer you one treatment, or a choice of treatments for recurrent prostate cancer. You may also be able to have your cancer monitored rather than treated (see below).

All treatments have advantages, disadvantages and side effects. All men are different and a particular side effect might be a problem for one man but not for another. It’s important to discuss your options with your doctor before deciding on a treatment. You could also talk through your options with your partner, family or friends, or speak to our Specialist Nurses.

What second-line treatments are there?

There are two main types of treatments – those that aim to get rid of the cancer (curative treatments) and those that aim to delay the cancer growing but won’t get rid of it.

Treatments aiming to get rid of the cancer

  • External beam radiotherapy useshigh-energy X-ray beams to destroy cancer cells. You might have it with or without hormone therapy.
  • Permanent seed brachytherapy involves implanting tiny radioactive seeds into your prostate.
  • High intensity focused ultrasound (HIFU) uses ultrasound waves to heat and destroy cancer cells in your prostate. HIFU is newer that some other treatments, so isn’t available everywhere.
  • 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 inside it.

Treatments aiming to control the cancer

  • Hormone therapy works by either lowering the amount of testosterone in the body or by stopping it from reaching the cancer cells, wherever they are in the body. Prostate cancer cells usually need testosterone to grow.
  • Chemotherapy uses anti-cancer drugs to kill cancer cells, wherever they are in the body. You may be offered chemotherapy alongside hormone therapy. It can cause some serious side effects so you will need to be fit enough to cope with these.

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.

Monitoring your prostate cancer

You may be able to have your cancer monitored, instead of having second-line treatment straight away. For many men, prostate cancer is slow-growing and may not cause any problems or symptoms, even without treatment. The aim of monitoring is to avoid or delay treatment, and the side effects that treatment can cause.

If you decide to have your prostate cancer monitored, your doctor and nurse will monitor you and your cancer closely for any changes. You will have regular PSA tests. You may also have other tests and scans.

If the tests show that your cancer is growing more quickly than expected, or if you have symptoms, talk to your doctor about starting second-line treatment.

 

Which second-line treatments are available to me?

Several things 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

This means it’s unlikely that all of the treatments will be available to you. Speak to your doctor or nurse about which ones are available to you. Read more about this in our fact sheet, If your prostate cancer comes back, A guide to treatment and support.

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’s used as your first treatment. This is because your first treatment may have already caused some damage to the tissue surrounding the prostate.

Side effects may also be more severe with a second-line treatment. And you might still be getting side effects from your first treatment.

Ask your doctor or nurse for more information about the possible side effects from the second-line treatments they offer you. Read our treatment pages to find out about side effects from different treatments. Finding out about possible side effects might help you to choose between your different treatment options, or whether you want to have any treatment.

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.

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 breathing exercises or listening to music.
  • 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.

References

Updated: November 2013 | Due for review: November 2015

  • List of references  

    Ullrich PM, Carson MR, Lutgendorf SK, Williams RD. Cancer Fear and Mood Disturbance After Radical Prostatectomy: Consequences of Biochemical Evidence of Recurrence. J Urol. 2003 Apr;169(4):1449–52.

    Punnen S, Cooperberg MR, D’Amico AV, Karakiewicz PI, Moul JW, Scher HI, et al. Management of Biochemical Recurrence After Primary Treatment of Prostate Cancer: A Systematic Review of the Literature. Eur Urol. 2013 Dec;64(6):905–15.

    National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.

    Mendenhall WM, Henderson RH, Hoppe BS, Nichols RC, Mendenhall NP. Salvage of Locally Recurrent Prostate Cancer After Definitive Radiotherapy: Am J Clin Oncol. 2014 Aug;37(4):411–6.

    National Institute for Clinical Excellence. High-intensity focused ultrasound for prostate cancer. Interventional procedure guidance 118. 2005.

    National Institute for Health and Clinical Excellence. Cryotherapy for recurrent prostate cancer. Interventional procedure guidance 119. 2005.

    Rosoff JS, Savage SJ, Prasad SM. Salvage radical prostatectomy as management of locally recurrent prostate cancer: outcomes and complications. World J Urol. 2013 Dec;31(6):1347–52.

    Mottet N, Bellmunt J, Briers E, Van den Bergh RCN, Bolla M, Van Casteren NJ, et al. Guidelines on prostate cancer. European Association of Urology; 2015.

    Kimura M, Mouraviev V, Tsivian M, Mayes JM, Satoh T, Polascik TJ. Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy. BJU Int. 2010 Jan;105(2):191–201.

    Pfister D, Bolla M, Briganti A, Carroll P, Cozzarini C, Joniau S, et al. Early Salvage Radiotherapy Following Radical Prostatectomy. Eur Urol. 2014 Jun;65(6):1034–43.

    Autran-Gomez AM, Scarpa RM, Chin J. High-Intensity Focused Ultrasound and Cryotherapy as Salvage Treatment in Local Radio-Recurrent Prostate Cancer. Urol Int. 2012;89(4):373–9.

    Gomez-Veiga F, Mariño A, Alvarez L, Rodriguez I, Fernandez C, Pertega S, et al. Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy. BJU Int. 2012;109(s1):17–21.

    Chade DC, Eastham J, Graefen M, Hu JC, Karnes RJ, Klotz L, et al. Cancer Control and Functional Outcomes of Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Systematic Review of the Literature. Eur Urol. 2012 May;61(5):961–71.

    Lawrentschuk N, Finelli A, Van der Kwast TH, Ryan P, Bolton DM, Fleshner NE, et al. Salvage Radical Prostatectomy Following Primary High Intensity Focused Ultrasound for Treatment of Prostate Cancer. J Urol. 2011 Mar;185(3):862–8.

    Ahmed HU, Ishaq A, Zacharakis E, Shaw G, Illing R, Allen C, et al. Rectal fistulae after salvage high-intensity focused ultrasound for recurrent prostate cancer after combined brachytherapy and external beam radiotherapy. BJU Int. 2009 Feb;103(3):321–3.

    Parekh A, Graham PL, Nguyen PL. Cancer Control and Complications of Salvage Local Therapy After Failure of Radiotherapy for Prostate Cancer: A Systematic Review. Semin Radiat Oncol. 2013 Jul;23(3):222–34.

    Gruca D, Bacher P, Tunn U. Safety and tolerability of intermittent androgen deprivation therapy: A literature review: IAD therapy in prostate cancer. Int J Urol. 2012 Jul;19(7):614–25.

    Silva FC da, Silva FMC da, Gonçalves F, Santos A, Kliment J, Whelan P, et al. Locally Advanced and Metastatic Prostate Cancer Treated with Intermittent Androgen Monotherapy or Maximal Androgen Blockade: Results from a Randomised Phase 3 Study by the South European Uroncological Group. Eur Urol. 2014 Aug;66(2):232–9.

    Botrel TEA, Clark O, dos Reis RB, Pompeo ACL, Ferreira U, Sadi MV, et al. Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis. BMC Urol. 2014;14:9.

    Magnan S, Zarychanski R, Pilote L, Bernier L, Shemilt M, Vigneault E, et al. Intermittent vs Continuous Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2015 Sep 17;1–10.

    Hackett G, Kell P, Ralph D, Dean J, Price D, Speakman M, et al. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med. 2008;5(8):1841–65.

    Discacciati A, Orsini N, Wolk A. Body mass index and incidence of localized and advanced prostate cancer--a dose-response meta-analysis of prospective studies. Ann Oncol. 2012 Jan 6;23(7):1665–71.

    Campeggi A, Xylinas E, Ploussard G, Ouzaid I, Fabre A, Allory Y, et al. Impact of Body Mass Index on Perioperative Morbidity, Oncological, and Functional Outcomes After Extraperitoneal Laparoscopic Radical Prostatectomy. Urology. 2012 Sep;80(3):576–84.

    Wolin KY, Luly J, Sutcliffe S, Andriole GL, Kibel AS. Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity. J Urol. 2010 Feb;183(2):629–33.

    Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer. 2011 Nov 8;105:S52–73.

    Thorsen L, Courneya KS, Stevinson C, Fosså SD. A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants. Support Care Cancer. 2008 Feb 15;16(9):987–97.

    Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical Activity after Diagnosis and Risk of Prostate Cancer Progression: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor. Cancer Res. 2011 May 24;71(11):3889–95.

    Mydin AR, Dunne MT, Finn MA, Armstrong JG. Early Salvage Hormonal Therapy for Biochemical Failure Improved Survival in Prostate Cancer Patients After Neoadjuvant Hormonal Therapy Plus Radiation Therapy—A Secondary Analysis of Irish Clinical Oncology Research Group 97-01. Int J Radiat Oncol. 2013 Jan;85(1):101–8.

    World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: WCRF/AICR; 2007.

    Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol. 2014 Feb 1;32(4):335–46.

    Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. J Pain Symptom Manage. 2012 Jan;43(1):96–110.

    Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, Bouvard V, et al. A review of human carcinogens—Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. 2009 Nov;10(11):1033–4.

    Zu K, Giovannucci E. Smoking and aggressive prostate cancer: a review of the epidemiologic evidence. Cancer Causes Control. 2009 Jun 27;20(10):1799–810.

    Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E. Smoking and prostate cancer survival and recurrence. JAMA J Am Med Assoc. 2011;305(24):2548.

    Huncharek M, Haddock KS, Reid R, Kupelnick B. Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies. J Inf. 2010;100(4).

    Moreira DM, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, et al. Cigarette smoking is associated with an increased risk of biochemical disease recurrence, metastasis, castration-resistant prostate cancer, and mortality after radical prostatectomy: Results from the SEARCH database. Cancer. 2014 Jan 15;120(2):197–204.

    Rohrmann S, Linseisen J, Allen N, Bueno-de-Mesquita HB, Johnsen NF, Tjønneland A, et al. Smoking and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2013;108(3):708–14.

    Islami F, Moreira DM, Boffetta P, Freedland SJ. A Systematic Review and Meta-analysis of Tobacco Use and Prostate Cancer Mortality and Incidence in Prospective Cohort Studies. Eur Urol. 2014 Dec;66(6):1054–64.

    Solanki AA, Liauw SL. Tobacco use and external beam radiation therapy for prostate cancer: Influence on biochemical control and late toxicity. Cancer. 2013;n/a – n/a.

    Grossmann M, Hamilton EJ, Gilfillan C, Bolton D, Joon DL, Zajac JD. Bone and metabolic health in patients with non-metastatic prostate cancer who are receiving androgen deprivation therapy. Med J Aust. 2011;194(6):301–6.