Sometimes, prostate cancer can return after treatment or spread to other areas of the body. This is known as recurrent prostate cancer. Treatment options will depend on several factors.

A doctor will continue to monitor an individual after they have completed initial treatment for localized prostate cancer. Blood test results or other imaging tests may reveal that the cancer has returned.

There are many possible treatments for recurrent prostate cancer, including surgery, radiotherapy, and hormone therapy. Sometimes, a doctor may suggest monitoring the condition rather than starting immediate treatment.

This article discusses how to identify recurrent prostate cancer as well as the possible treatments and the side effects they may cause.

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Prostate-specific antigen (PSA) is a protein the body produces in the prostate gland. The higher a person’s PSA levels are, the more likelyTrusted Source it is that they have prostate cancer, although this is not a definite sign of the condition.

If a doctor discovers high PSA levels after a checkup, they may need to perform a physical examination or run more tests. These may include CT, MRI, or bone scans, which may help a doctor determine whether the cancer has returned or spread to other areas of the body.

Possible signs and symptoms of recurrent or spreading prostate cancer include:

Two types of recurrence can occur: biochemical or radiographic. Biochemical recurrence occurs when there is a rise in PSA levels in the blood. Radiographic recurrence means there is evidence of cancer on a scan, which would also usually have an elevated PSA.

When a doctor cannot detect cancer on scan results, but the individual has a high PSA level, they may choose to move forward with active surveillance. Prostate cancer is oftenTrusted Source slow growing, and a doctor may decide to regularly monitor it to assess if and when treatment is necessary.

A doctor will consider active surveillance when the cancer is low riskTrusted Source, meaning it has not spread to any other part of the body and is growing very slowly or not at all.

Doctors may also consider prostate cancer to be low risk if it:

  • is only present on one lobe (side) of the prostate
  • takes up less than half of the affected lobe
  • has not spread to lymph nodes
  • has not led to the growth of tumors
  • has nonaggressive cells that have shown little mutation

The type of treatment that a doctor may offer for recurrent prostate cancer depends on many factors, such as a person’s overall health and the treatment they have already had.

Treatment options may also depend on if and where the cancer has spread within the body.

Cancer that has not spread from the prostate

When the cancer has not spread from the area of the prostate, or if a doctor cannot see signs of cancer on scan results, there are several treatment options.

These can include:

  • Surgery: A radical prostatectomy is a procedure to remove the prostate and the surrounding tissue. The 10-year survival rate for those who undergo this procedure is 85–99%Trusted Source.
  • Radiation therapy: A doctor may use this treatment if a person has already had surgery but some cancer still remains in the prostate. If a person has already undergone radiation therapy, a doctor may advise against repeating it to limit the body’s exposure to radiation.
  • Ablative therapy: Ablative therapies include cryotherapy and high intensity focused ultrasound (HIFU). A 2021 reviewTrusted Source found that cryotherapy offered a 44.2% biochemical recurrence-free rate after 10 years as a treatment following radiation therapy and 28.7% for HIFU.

Cancer that has spread to nearby areas of the body

When cancer has spread from the prostate to nearby areas of the body, a doctor may recommend hormone therapy with or without radiation therapy.

Hormone therapy — also called androgen deprivation therapy (ADT) — reduces the levels of testosterone in the body that help prostate cancer grow.

Sometimes, an individual may decide to undergo a procedure called an orchiectomy, which entails removing the testicles. As the testicles produce a lot of androgen hormone, an orchiectomy can cause mostTrusted Source prostate cancers to stop growing.

Historically, surgeons removed both testicles to lower a person’s testosterone levels to treat prostate cancer. Now, doctors may administer medications that mimic the effect of shutting off the testicles without performing surgery. This comes in the form of an injection called leuprolide (Lupron).

Leuprolide works by blocking the luteinizing hormone and follicle-stimulating hormone, which usually stimulate testosterone production in the testicle.

Cancer that has spread to other parts of the body

When prostate cancer spreads to more distant areas of the body — often the bones or lymph nodes — a doctor can no longer treat the cancer with surgery or radiation. In these cases, the individual will likelyTrusted Source receive ADT.

Several clinical trials have found that those who receive both ADT and another type of hormone therapy — abiraterone/prednisone, enzalutamide, or apalutamide — tend to have positive outcomes. Several studiesTrusted Source have shownTrusted Source that using these hormone therapies can increase survival rates and effectively delay the progression of metastatic prostate cancer. This refers to cancer that has spread to other organs.

Sometimes, a doctor may also recommend chemotherapy or immunotherapy.

There are possible side effects for any cancer treatment. Individuals can discuss these with their healthcare team before deciding on how to treat their cancer.

Possible side effects of radiation therapy includeTrusted Source:

Possible side effects of a prostatectomy includeTrusted Source:

  • erectile dysfunction
  • urinary incontinence
  • changes in orgasm
  • infertility
  • lymphedema
  • change in length of penis

Possible side effects of ablation therapies include:

Possible side effects of hormone therapy includeTrusted Source:

The treatment option a person ends up choosing for recurrent prostate cancer will depend on several factors. The individual should discuss all the options with their healthcare team, taking into consideration the possible side effects and likely outcomes of each one.

Individuals who decide not to treat their cancer may want to discuss active surveillance or watchful waiting with their doctor.

Having recurrent prostate cancer and going through treatment for it can be a difficult time, both mentally and physically. Individuals can talk with their healthcare team about what support may be available.

People can also find support via online resources or by joining local groups. The American Cancer SocietyTrusted Source provides a database of a range of support programs, including financial support for those living with cancer. In addition, Zero Prostate Cancer provides both in-person and online support groups for individuals with prostate cancer.

In many cases, when first-line treatments are ineffective or prostate cancer returns after treatment, there are second-line treatments available. Attending regular checkups and being vigilant about symptoms can help a person identify recurring prostate cancer early.

The type of treatment a doctor may recommend for recurring prostate cancer will depend on the type and location of the cancer as well as the individual’s health and circumstances. Sometimes, a doctor may decide that active surveillance is more suitable and that the individual does not currently require treatment.