If prostate cancer comes back

For many men prostate cancer can be cured with surgery or radiotherapy. But in up to 1 in 3 men the cancer comes back (recurs) some time after treatment. After you've finished treatment doctors regularly use blood tests to check levels of a protein called prostate specific antigen (PSA). They use PSA to help show whether the cancer has come back. The level varies according to the type of treatment you had. If your PSA does start to go up, your doctor will monitor how quickly or slowly it is increasing to see whether you need treatment. There is information below about

• PSA after surgery to remove the prostate
• PSA after external beam radiotherapy
• PSA after internal radiotherapy (brachytherapy)

PSA after surgery to remove the prostate

After surgery to remove the prostate, the PSA level in your blood normally drops to below 0.1ng/ml within a month or so. If the PSA does not go below 0.2ng/ml and starts going up, it can be a sign that the cancer has started growing again from cancer cells left behind in the prostate area, or that had spread elsewhere in your body.

PSA after external beam radiotherapy

After external radiotherapy to the prostate, PSA normally drops slowly to a very low level. This may take months or sometimes years. If it starts to rise, it may be a sign that the cancer has come back in your prostate gland or in another part of your body. 

But if you had hormone therapy with your radiotherapy, PSA may rise temporarily when hormone therapy is stopped. You may have hormone therapy for as little as 3 months or for up to 3 years. After hormone therapy finishes, your doctor will monitor your PSA. If it keeps going up, or goes up by more than 2 or 3 ng/ml, it can be a sign that the cancer is growing again.

PSA after internal radiotherapy (brachytherapy)

PSA can rise temporarily after internal radiotherapy. Doctors call this the PSA bounce. The level does not normally go down to zero. But if it goes up by more than 2ng/ml it can be a sign that the cancer is growing again.

If the PSA level starts to go up, doctors call this biochemical relapse. Your treatment team will keep a close watch on you and decide what to do. Sometime PSA goes up very slowly or levels off. You may not need any further treatment, but your doctors will continue to check your PSA regularly. They call this watchful waiting. Prostate cancer often grows very slowly and it is not always clear whether it is necessary to start treatment if PSA levels rise. Sometimes it may be better to wait and have treatment if the cancer starts to cause symptoms. 

If the PSA level is rising quickly – for example, if it doubles over a few months – your doctor may ask you to have tests such as an MRI scan or ultrasound scan. If they think the cancer has come back in the area of the prostate they may recommend treatment. What is best for you will depend on the treatment that you had originally.

If you had your prostate gland removed when you were first diagnosed but the cancer has come back, your doctor may recommend radiotherapy to the area of the prostate. They may also recommend hormone therapy.

If you had radiotherapy as your first treatment, your doctor may recommend hormone therapy. Or they may recommend surgery to remove the prostate gland, freezing therapy (cryotherapy), or high intensity ultrasound (HIFU).

If cancer has spread to other parts of the body, it cannot be cured. But treatment may help to control it for a long time. You may have hormone therapy to lower testosterone levels. Or bisphosphonate drugs to help slow the growth of prostate cancer cells in the bones. 

If hormone therapy is no longer working your doctor may recommend chemotherapy. There is information about treatment for prostate cancer that has spread in this section. 

Finding out that cancer has spread can be a big shock. It may help to talk to a close friend or relative about how you feel. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience.

If you would like to talk to other people in a similar situation, look at our list of prostate cancer organisations to find help and support. To find out about counselling look in our counselling section. Your GP may be able to put you in touch with a local counsellor.

You can contact your specialist nurse for information if you need to. You can also contact the Cancer Research UK nurses.

If you want to go online to find people to share experiences with, try our online forum, CancerChat.

Research is looking into treatments such as chemotherapy, bisphosphonates and a drug called celecoxib to help men whose cancer has come back in the area of the prostate gland. You can read about these on the prostate cancer research page.