Treating Recurrent Prostate Cancer

Medically Reviewed by Nazia Q Bandukwala, DO on May 29, 2023
Written by Stephanie Watson
5 min read

Prostate cancer can come back, even after you've had treatment and your doctor declared you cancer-free. Prostate cancer that returns after treatment is called recurrent prostate cancer.

Prostate cancer returns for a couple of reasons:

A prostate cancer recurrence is often treatable. It may even be curable. The treatments you'll get this time around will be different from the ones you had before. Finding out your cancer has returned can bring back some of the same emotions you felt after your initial diagnosis. Your doctor, nurse, or a counselor can help you manage these feelings as you get ready for the next phase of treatment.

Recurrent prostate cancer usually doesn't cause symptoms unless it has spread to other parts of your body. Then you might have:

Often, the first sign that your cancer has returned is rising levels of prostate specific antigen, or PSA, in a blood test. Regular PSA testing is one way your doctor monitors you for a recurrence.

This test can't show for sure that your cancer is back. Your doctor can do a biopsy to confirm that your cancer has returned, or a CT or MRI scan to see if it has spread.

Doctors also have  imaging tests called positron emission tomography, or a PET scan, that may be better than other scans. The PET scan and PMSA PET scan use a radioactive tracer to find out where the cancer has spread and predict which treatment might work best against it. The PMSA PET scan can detect prostate cancer that has spread.

Once you know that your cancer has returned, you and your doctor will choose a treatment. A few factors go into making the decision, including:

  • Which type of treatment you had before
  • How aggressive your cancer is
  • Whether, and where, it has spread
  • How much time has passed since your first treatment
  • How quickly your PSA level is rising
  • Your overall health

 

Recurrent prostate cancer treatment is called second-line or salvage therapy. Treatments aim to do one of two things: get rid of your cancer (curative) or slow it down (control).

Curative treatments include:

  • Radiation therapy. It uses high-energy X-ray beams to kill cancer cells. The radiation can come from a machine outside your body, which is called external beam radiation. Or you can get radiation through tiny seeds or a tube placed into your prostate, which is called brachytherapy.
  • Cryotherapy. This treatment uses extreme cold to kill cancer cells.
  • Surgery. Radical prostatectomy removes your prostate and some of the tissue around it.

Control treatments include:

  • Hormone therapy. It lowers the amount of the hormone testosterone in your body, or blocks it from getting to your cancer cells. Testosterone fuels the growth of prostate cancer.
  • Chemotherapy. This treatment uses strong medicines to kill cancer cells.

 

Your doctor will recommend a treatment based on the location of your cancer and which treatment you had before.

When the cancer is only in your prostate:

  • If you had surgery before: You can now have radiation therapy, sometimes combined with hormone therapy. Or you might get hormone therapy on its own.
  • If you had radiation therapy before: Your options include cryotherapy and surgery. Doctors don't recommend getting radiation a second time because it can cause severe side effects. Brachytherapy may still be an option if you had external beam radiation the last time.

If cancer has spread to other parts of your body:

  • Hormone therapy is often the treatment for recurrent prostate cancer that is advanced. You may get chemotherapy, too.

 

Sometimes prostate cancer doesn't respond to hormone therapy or other treatments, or it stops responding after a period of success. So many new treatments are available for recurrent prostate cancer that you still have a lot of options.

Your doctor might recommend one of these treatments:

Sipuleucel-T (Provenge). This is a prostate cancer vaccine. It boosts your immune system response to help it attack cancer cells.

Immunotherapy. Pembrolizumab (Keytruda) takes the brakes off of your immune system so that it can fight the cancer better.

Targeted therapy. Olaparib (Lynparza) and Rucaparib (Rubraca) are drugs called PARP inhibitors. They prevent cancer cells from repairing their damaged DNA. When cancer cells can't fix themselves, they die. These drugs are for people who have mutations in the BRCA genes.

Another option is to enroll in a clinical trial. These studies test out new treatments, including cancer vaccines and drugs called monoclonal antibodies, that are being reviewed for safety and effectiveness. The experimental treatments you get in a clinical trial might work better against your cancer than treatments you've already tried, but they have yet to be approved for wider use.

Any cancer treatment can cause side effects. For example, hormone therapy side effects include erectile dysfunction, hot flashes, and breast tissue tenderness.

You're more likely to have side effects after second-line treatments, because the first treatment you had might have already damaged the tissue around your prostate. The side effects can also be more severe during the second round of treatment.

Just because a treatment can cause a side effect doesn't mean it will affect you that way. Ask your doctor or nurse what types of side effects to expect, and what to do if you have any.

Not necessarily. If your PSA level hasn't risen much and you're not at high risk of the cancer spreading, "active surveillance” could be an option.

Active surveillance means your doctor will monitor your cancer with regular PSA tests. If it starts to grow or cause symptoms, then you'll start on a treatment.

Prostate cancer often grows very slowly and never becomes life-threatening. Active surveillance lets you delay treatment and avoid side effects, sometimes for many years. Another reason to wait is if you're still recovering from side effects of your first treatment.

Not everyone is comfortable with the idea of putting treatment on pause. It's a personal decision that you should make only after carefully weighing the pros and cons with your doctor.

You'll see your doctor regularly to check how well your cancer is responding to the second treatment. If your cancer comes back again, you'll get hormone therapy to control it. Or, you may get other treatments, like chemotherapy. You could also enroll in a clinical trial.