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If your prostate cancer comes back

For many men prostate cancer can be cured with surgery or radiotherapy.

After treatment you have follow up, which usually includes regular blood tests. Your doctor checks levels of a protein called prostate specific antigen (PSA). 

An increase in PSA can mean there are prostate cancer cells in your body. The cells might be in the prostate area. Or they might have spread elsewhere in your body.

Your doctor will monitor if your PSA level rises and how quickly the rise happens. You might need further treatment if it rises.

Prostate cancer that comes back after treatment is called recurrent prostate cancer or a recurrence. It happens in 1 in 3 men after treatment for early prostate cancer.

PSA levels after treatment

After surgery to remove your prostate (prostatectomy)

PSA levels are usually extremely low (below the normal range) about a month after surgery.  They should be < 0.02 ng/ml.  If it increases above 0.2 ng/ml this can indicate recurrence.

After external beam radiotherapy

PSA levels usually get lower slowly over months or years.  Defining the limit for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment (the nadir) is taken as a sign of recurrence, or 3 increases in a row (consecutive increases).

After internal beam radiotherapy (brachytherapy)

PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly.  Usually a level of 2 ng/ml above the lowest point after treatment (the nadir) is taken as a sign of recurrence.

After hormone treatment

If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static.  If it rises this may suggest the cancer is becoming resistant to the hormone treatment.

An increased PSA level

After curative or radical treatment, a rising PSA level is called a biochemical relapse. Your PSA level may increase steadily. After some time this might stabilise. It may stay at a high level.

You might not need to start treatment straight away. Your doctor will continue to monitor your PSA levels regularly. You might have a scan if your PSA rises quickly.

The choice about whether to have treatment and what treatment to have will depend on:

  • the treatment you have already had
  • your general health
  • where your cancer is
  • if it has spread to other parts of your body

Treatment options after recurrence

After surgery to remove your prostate (prostatectomy)

Your doctor might recommend:

  • radiotherapy to the prostate
  • hormone treatment

After radiotherapy to the prostate

Your treatment options may be:

  • surgery to remove your prostate (prostatectomy)
  • hormone treatment
  • cryotherapy
  • high frequency ultrasound (HIFU)

After hormone treatment

If hormone treatment is no longer controlling your cancer, your doctor may suggest:

  • abiraterone (Zytiga)
  • enzalutamide (Xtandi)

Newer forms of treatment such as chemotherapy may also be used.

Active surveillance

This means keeping treatment to cure prostate cancer in reserve. This is usually for localised prostate cancer. You may never need treatment.

You will have regular blood tests, prostate biopsies, and digital rectal examinations.

Watch and wait

This means keeping treatment to control growth of prostate cancer in reserve. This is usually for locally advanced or metastatic prostate cancer. You may never need treatment.

Your doctor will test your PSA level regularly. Tell them if you have any problems with pain in your bones or with passing urine.

If your prostate cancer has spread

If cancer has spread to other parts of your body it can’t be cured. Treatment might help to control it for a long time and help to control symptoms. This may be:

  • hormone treatment to lower your testosterone levels
  • bisphosphonates to help with bone pain
  • radiotherapy to particular parts of the skeleton
  • treatment with 'liquid' forms of radiotherapy such as radium-223

If hormone therapy is no longer working for you, you might have:

  • chemotherapy
  • steroid tablets (such as dexamethasone)

Research

Clinical trials research aims to improve treatment, by making existing treatment better and developing new treatments. Your doctor might ask if you are willing to take part in a trial.

Find out about trials for advanced prostate cancer

Emotional support

Finding out that cancer has come back or spread can be a big shock. It might help to talk to a close friend or relative about how you feel.

Last reviewed: 
12 Sep 2016
  • Assessing the Optimal Timing for Early Salvage Radiation Therapy in Patients with Prostate-specific Antigen Rise After Radical Prostatectomy
    N Fossatti and others
    European Urology, 2016, vol 69, No 4, 728-733

  • Meta-Analysis Evaluating the Impact of Site of Metastasis on Overall Survival in Men With Castration-Resistant Prostate Cancer
    S Halabi and others
    Journal of clinical oncology, 2016, vol 34, No 14, 1652-1659

  • Prostate cancer diagnosis and management 
    National Institute for Health and Care Excellence, 2014

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About Cancer generously supported by Dangoor Education since 2010.​