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

Even after successful treatment of prostate cancer, it’s 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 prostate-specific antigen (PSA) levels in your blood. After successful treatment, PSA levels tend to drop significantly. If PSA levels suddenly rise, it can be an indication that cancer cells are still present.

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

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

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

How often does prostate cancer recur?

Your odds of recurrence may depend on your treatment plan. A 2018 review suggests that prostate cancer has a 20% to 40% chance of returning after a radical prostatectomy (RP), which is surgery to remove your prostate gland, but this chance depends on your PSA levels after the procedure.

According to the Prostate Cancer Foundation, the odds of prostate cancer returning after surgery or radiation are 25% to 33%.

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Some of the early symptoms of recurrent prostate cancer to watch out for include:

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

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

  • feeling a deep pain in your bones
  • swelling and loss of sensation in your pelvic area, legs, or feet
  • losing weight for no obvious reason
  • having constipation or irregular bowel movements

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

Is recurrent prostate cancer more aggressive?

Recurrent prostate cancer isn’t necessarily more aggressive than when it first appears before treatment.

The cancer is often just as aggressive as it was before. If the first diagnosis involved aggressive or more advanced prostate cancer, it’s more likely that your recurring prostate cancer will also be aggressive.

Make sure you understand your Gleason score when a doctor first diagnoses prostate cancer. The score can help you determine how aggressive the cancer may be if it returns.

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

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

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

You may need other treatments if prostate cancer spreads 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 address cancer with specific changes in 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 another 5 years or more after successful treatment, especially if they’ve had an RP.

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

There’s no sure way to stop prostate cancer from recurring, but here are some tips to help prevent prostate cancer from coming back:

  • Stay vigilant: Check your body for any early symptoms of recurrence. Talk with a doctor about blood testing, biopsies, and imaging tests to help catch recurring prostate cancer quickly.
  • Make dietary changes: Some foods, such as many fruits and vegetables, may reduce your cancer risk. They’re 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 can increase your risk of prostate cancer.
  • Avoid alcohol and tobacco: Alcohol and tobacco can both increase your risk of many types of cancer, including prostate cancer.
  • Get enough vitamin D: A 2018 review of studies 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 each day or eat vitamin D-rich foods such as fish, orange juice, and oatmeal.
  • Have sex or masturbate: A 2016 study suggests that ejaculating at least 21 times a month can reduce your risk of prostate cancer, but more follow-up research is needed to support this claim.

Resources for support

Several resources are available if you need support while you’re treating and coping with prostate cancer. Consider the following:

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As many as 2 out of 5 people with prostate cancer may have it come back after treatment. Try to get regular screenings and testing after your initial prostate cancer treatment, which will help you and a doctor catch any early signs or symptoms of a recurrence.

If prostate cancer does return, there are still treatment options available. Most people have good results after treating recurrent prostate cancer. Even if your cancer isn’t curable at this point, treatments can still help reduce symptoms.