Treatments for recurrent prostate cancer

Recurrent prostate cancer is cancer that comes back (recurs) after it has been treated. Recurrent prostate cancer is also diagnosed when the prostate-specific antigen (PSA) level starts to rise quickly after initial treatment but there are no other signs of cancer. This is called a biochemical recurrence or PSA failure.

The following are treatment options for recurrent prostate cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The type of treatment that you receive will depend on:

• the treatments you've already had
• where the cancer comes back
• whether the cancer has spread
• your overall health and whether you have other illnesses
• your age and life expectancy
• your personal preferences

Treatment options after a radical prostatectomy for cancer that recurs in or around the prostate include:

• radiation therapy with or without hormone therapy
• hormone therapy
• watchful waiting

Treatment options after radiation therapy for cancer that recurs in or around the prostate include:

• watchful waiting
• brachytherapy
• surgery
• cryosurgery
• hormone therapy
• high-intensity focused ultrasound (HIFU)

Treatment options for prostate cancer that has spread to other parts of the body include:

• hormone therapy
• chemotherapy
• targeted therapy (if the cancer has a specific genetic mutation)
• treatments for bone metastases

Radiation therapy may be offered for prostate cancer that recurs after a radical prostatectomy. It uses high-energy rays or particles to destroy cancer cells. Radiation therapy may be given with or without hormone therapy.

External radiation therapy is the type of radiation therapy most often used. It may be given together with hormone therapy.

If the cancer was treated with surgery and it comes back in the same area of the prostate, radiation therapy may be used to treat it. If the cancer was treated with external radiation therapy, this treatment can't be given to the same area again. This is because the radiation would do too much damage to the organs around the prostate, such as the bladder and rectum.

Brachytherapy is a form of radiation therapy that uses a radioactive substance (radioactive isotope) placed directly into the tumour or very close to it (called an implant). You may be offered brachytherapy to treat a recurrence if external radiation therapy was first used to treat the tumour in the prostate and if the cancer hasn't spread to other parts of the body.

Hormone therapy (also called androgen deprivation therapy) may be used to treat prostate cancer that recurs after surgery or radiation therapy. It is the main treatment for prostate cancer that recurs outside of the prostate area. It decreases the levels of hormones or blocks certain hormones to slow the growth and spread of cancer cells. Hormone therapy may be given alone or along with radiation therapy. If one type of hormone therapy isn't helpful then another type may be used.

Hormone therapies may be used on their own or combined and include:

• a luteinizing hormone–releasing hormone (LHRH) agonist
• an LHRH antagonist
• an anti-androgen
• an androgen synthesis inhibitor
• an orchiectomy (surgery to remove the testicles)

Find out more about hormone therapy for prostate cancer.

You may be offered watchful waiting if you are elderly and don't want the side effects that come along with treatment or are unable to have treatment due to other medical conditions. Watchful waiting is less intensive than active surveillance. There are no routine tests and it relies more on changes in symptoms. If you start to have symptoms while under watchful waiting, your doctor may discuss treatment for the symptoms.

Find out more about watchful waiting for prostate cancer.

Surgery is rarely used to treat recurrent prostate cancer that was treated previously with radiation therapy.

Cryosurgery is a procedure that uses extremely cold or freezing temperatures to destroy abnormal cells or tissue. It is sometimes used to treat cancer that recurs in the prostate when radiation therapy was the first treatment given. Cryosurgery may be used if you are unable to have surgery or radiation therapy because of other health conditions.

Find out more about cryosurgery.

High-intensity focused ultrasound (HIFU) uses focused ultrasound waves to create intense heat, which destroys cancer cells. Right now, HIFU is an experimental treatment for prostate cancer. Sometimes doctors use it to treat prostate cancer that comes back after it has been treated with radiation therapy.

Chemotherapy may be offered for prostate cancer that recurs outside of the prostate. It uses anticancer drugs to destroy cancer cells.

Docetaxel and prednisone are the drugs used most often. They are used along with hormone therapy.

Find out more about chemotherapy for prostate cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer and limit harm to normal cells. Targeted therapy may be used to treat recurrent prostate cancer that has certain genetic mutations.

Targeted therapy drugs that may be used include:

• olaparib (Lynparza)

Find out more about targeted therapy for prostate cancer.

When prostate cancer spreads to other parts of the body, it most often spreads to the bones. The most common treatments for prostate cancer that has spread to the bones are:

• bisphosphonates, such as zoledronic acid (Zometa)
• denosumab (Xgeva), which is a type of monoclonal antibody therapy
• corticosteroids, such as prednisone and dexamethasone
• external radiation therapy
• systemic radiation therapy with radium-223 dichloride (Xofigo)
• a procedure to stabilize a collapsed bone (called kyphoplasty)
• pain medicines

Find out more about bone metastases, including treatments and supportive therapies.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with prostate cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.