Recurrent prostate cancer: symptoms, treatment and outlook

Prostate cancer can recur if the initial cancer spreads to other areas or if the first round of treatment doesn’t catch everything. Still, 5 out of 6 people with recurrent prostate cancer live 5 years or more after treatment.

Even after successful treatment of prostate cancer, it is possible for the cancer to return. Prostate cancer that returns after successful treatment is called “recurrent prostate cancer”.

Doctors usually detect prostate cancer by measuring levels of prostate-specific antigen (PSA) in the blood. After successful treatment, PSA levels tend to drop significantly. If PSA levels suddenly rise, it could be an indication that cancer cells are still present.

There’s still a lot you can do to treat prostate cancer if it comes back. Read on to learn what causes prostate cancer to come back, what symptoms to look out for, and what treatment options are available.

Some of the main reasons why prostate cancer can recur include:

  • Metastasis (spread): Cancer cells may have spread to different regions, such as bones or nearby lymph nodes. The treatment may not have completely eliminated the cells.
  • tumor size: The treatment may not have completely eliminated the larger tumors, which means that some cancerous tissue may still be present in the area.
  • Stage in treatment: Advanced prostate cancer is more likely to spread beyond the prostate and metastasize to nearby tissue or bone. The spread that occurs at an advanced stage can make cancer cells more difficult to remove, so treatment may still leave some cancer tissue behind.
  • Aggressiveness: Prostate cancer with a higher Gleason score is more likely to return even after treatment. This score evaluates the shape of cancer cells under a microscopic view. The more abnormal the cells appear, the more likely they are to grow rapidly and recur.

Some of the first symptoms of recurrent prostate cancer to look out for include:

  • feeling extremely tired for no reason
  • having trouble urinating
  • notice abnormal colors in the skin or the whites of the eyes (jaundice)
  • unexplained pain in the lower back
  • noticing blood in your urine or semen
  • having trouble breathing

If your recurring prostate cancer becomes more advanced, you may notice some of the following symptoms:

  • feeling an ache deep in your bones
  • swelling and loss of feeling in the pelvic area, legs, or feet
  • lose weight for no apparent reason
  • having constipation or irregular bowel movements

Doctors typically check your PSA levels at follow-up appointments. Rising PSA levels are a sign that the prostate cancer has returned. Experts call the rise in PSA levels after initial treatment a “biochemical recurrence” and it can occur even without symptoms.

If your first case of prostate cancer was advanced but has not spread beyond the prostate, a doctor may have performed a RP to remove the prostate and stop the cancer cells from spreading.

If you’ve had a RP but the prostate cancer still comes back, a doctor may suggest:

  • radiation therapy to destroy cancer cells
  • hormone therapy to help reduce levels of hormones called “androgens” that can make prostate cancer more aggressive
  • cryotherapy to destroy cancer cells using extremely cold temperatures

You may need other treatments if your prostate cancer has spread to nearby tissues, including:

  • an orchiectomy to remove one or both testicles that may be affected
  • chemotherapy along with radiation therapy to kill cancer cells
  • the prostate cancer vaccine (Provenge) to help boost your immune response to prostate cancer cells
  • immunotherapy to treat cancer with specific changes to its DNA
  • targeted therapies (e.g. Lynparza or Rubraca) if you have a mutation in your BRCA gene

The outlook for people with recurrent prostate cancer depends on how aggressive and advanced the cancer is.

According to a 2016 study, more than 83% of people with recurrent prostate cancer live at least 5 years or more after successful treatment, especially if they have had RP.

A 2022 study found that 91% of people with recurrent prostate cancer lived for 5 years without further cancer spread. After 10 years, 77% of people were still alive.

There is no sure way to prevent prostate cancer from coming back, but here are some tips to help prevent prostate cancer from coming back:

  • Stay tuned: Check your body for any early symptoms of recurrence. Talk to a doctor about blood tests, biopsies, and imaging tests to help detect recurrent prostate cancer quickly.
  • Make dietary changes: Some foods, such as many fruits and vegetables, can reduce your risk of cancer. They are also good for your overall health.
  • Maintain a moderate weight: In addition to a healthy diet, exercise regularly to maintain your overall health and a moderate weight. A 2016 review suggests that having obesity may increase your risk of prostate cancer.
  • Avoid alcohol and tobacco: Alcohol and tobacco can increase the risk of many types of cancer, including prostate cancer.
  • Get enough vitamin D: A 2018 study review suggests a link between higher levels of vitamin D in your body and a lower risk of prostate cancer. Try to get at least 15 minutes of direct sunlight every day or eat foods rich in vitamin D such as fish, orange juice and oatmeal.
  • Have sex or masturbate: A 2016 study suggests that ejaculating at least 21 times per month may reduce the risk of prostate cancer, but more follow-up research is needed to support this claim.

Up to 2 out of 5 people with prostate cancer may come back after treatment. Try to get regular exams and tests after your initial prostate cancer treatment, which will help you and a doctor catch any early signs or symptoms of recurrence.

If the prostate cancer returns, there are still treatment options available. Most people have good results after treatment for recurrent prostate cancer. Even if your cancer is not curable at this point, treatments can still help reduce your symptoms.

Recurrent prostate cancer: symptoms, treatment and outlook

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