Treatments for Recurrent Prostate Cancer

Recurrent prostate cancer is any prostate cancer that comes back or reemerges after your initial treatment ends. It can happen if your first treatment didn't get rid of all the cancer. It also can happen when hidden cancer cells spread or start growing again. Your prostate cancer may have been undertreated. It may also have been at a more advanced stage than your care team initially thought. Sometimes recurrent prostate cancer can only be detected with a prostate-specific antigen (PSA) blood test.

When prostate cancer recurs, you'll have new decisions to make with your doctor about the best way to treat it. The best option for you will depend on factors including:

• Earlier treatment
• Where the cancer is located in your body
• The nature of the recurrent cancer
• Other health conditions you have
• Your personal preferences and treatment goals

Definitive radiation therapy may be an option if you've already had your prostate fully removed (radical prostatectomy) and your cancer comes back in or around the area where your prostate gland was. Studies have shown this works better when combined with hormone therapy. If your doctor suggests radiation to treat your remaining or recurrent prostate cancer, ask if you should take medicine to block testosterone and other hormones, too.

When prostate cancer comes back locally after radiation therapy that was intended to cure it, surgery may be an option. Your prostate may be removed by open or minimally invasive surgery. Because radiation therapy causes scarring, a salvage prostatectomy is a more difficult procedure than a standard prostatectomy. Ask your doctor about the potential side effects and risks.

Ablative therapies use other means to ablate, or destroy, cancer cells. They can treat areas where your recurrent cancer is. This type of therapy is focused, so it only works if your doctors can spot the recurrent cancer. Options include:

• Cryotherapy, which uses extreme cold
• High-intensity focused ultrasound (HIFU), which uses focused sound waves
• Proton beam therapy, which uses high-energy proton beams

Another round of radiation therapy may also be an option, but it comes with more risks.

Brachytherapy is a type of internal radiation. It uses radioactive seeds that are about the size of a grain of rice. Your doctor will place these seeds into your prostate or the area where your prostate was before its removal. The seeds may be placed permanently or temporarily. When prostate cancer comes back locally, or without spreading, brachytherapy can be a good option.

Active surveillance means that your doctor will monitor you closely. This approach may be an option if the only sign of your recurrent cancer is a PSA blood test. Sometimes there can be signs of a recurrence even when a cancer isn't visible on imaging tests. Because many prostate cancers are slow-growing, it may take a long time for your recurrent cancer to cause symptoms. Your doctor can watch how fast your PSA is rising to help decide whether it's best to start hormone therapy or other treatments.

If your recurrent cancer has spread to lymph nodes in your pelvis, but it hasn't reached other parts of your body, your options for second-line treatment may depend on what type of treatment you had before. If your prostate was removed, you may consider radiation therapy to your pelvic area. You'll likely take hormone therapy, too. After first-line radiation, your options may include:

• Hormone therapy
• Surgery to remove lymph nodes
• Radiation to pelvic lymph nodes

If your cancer has spread to more distant parts of your body, you may have it in other lymph nodes, your bones, or other internal organs. Options for treating recurrent, metastatic prostate cancer include:

• Hormone therapy
• Chemotherapy

You might take more than one hormone therapy. You may also take chemotherapy and hormone therapy together.

You'll have more treatment options today when recurrent, metastatic prostate cancer doesn't respond to standard hormone therapy. Your options will depend on other features of your cancer and may include:

• Other hormone therapies
• Immunotherapy
• Chemotherapy
• Radiopharmaceuticals
• Targeted therapy

Other therapies may help to treat cancer in your bones. These include:

• Bisphosphonates
• External radiation therapy targeting cancer in your bones
• Radiopharmaceuticals
• Ablative therapy targeting tumors in your bones

Clinical trials are careful studies by teams of doctors and researchers. They test new treatments or new treatment combinations to see if they are safe and if they work. Sometimes they measure how well a new treatment works compared to other options. Clinical trials can be a way to expand your treatment options and receive new medicines before they are otherwise available. If you're interested in a clinical trial, ask your doctor if there's one you might be eligible for. You can search for clinical trials in recurrent prostate cancer at ClinicalTrials.gov.