For many men, hearing that prostate cancer has returned—or wasn’t completely gone after treatment—can feel like a punch to the gut. But here’s the good news: even when prostate cancer comes back, there are still treatment options, and in many cases, very effective ones.
What Happens Next?
When a PSA level starts creeping up again after treatment, it’s a sign the cancer might not be gone entirely. But that doesn’t mean it’s untreatable. We now have better imaging tests like MRI, PET scans, or bone scans that can help us figure out exactly where the cancer is hiding. Based on this, we can tailor the next steps to ensure the best outcome for you.
If the Cancer Is Still Localized
If the cancer is still in or near the prostate:
After surgery, radiation therapy can target any remaining cancer cells. Sometimes we add hormone therapy to improve results.
After radiation: Surgery (prostatectomy) or treatments like cryotherapy or high-intensity focused ultrasound (HIFU) may help. These come with more side effects, but in select cases, they’re worth considering.
If the only sign is a rising PSA and scans show no cancer, we may monitor closely—what we call active surveillance. This is especially true if the PSA is rising slowly and you’re feeling well.
But if the PSA is rising quickly or your original cancer was aggressive, it may be time to act sooner, even before cancer shows up clearly on imaging.
If the Cancer Has Spread Nearby
When the cancer has reached nearby pelvic tissues or lymph nodes:
Post-surgery: Radiation to the pelvis plus hormone therapy is often the go-to.
Post-radiation: Options include hormone therapy, monitoring, or in some cases, lymph node surgery.
If the Cancer Has Spread Beyond
When prostate cancer spreads, it usually heads to the bones or distant lymph nodes first. Hormone therapy remains the cornerstone treatment—it works well for most men at first.We might use:
Hormone shots or pills to lower testosterone
Newer hormone-blocking drugs like abiraterone or enzalutamide
When the cancer spreads to the bones, we can also use bone-strengthening medications, targeted radiation, or even treatments that deliver radiation directly to cancer cells.
What If Hormone Therapy Stops Working?
This is called castration-resistant prostate cancer (CRPC)—when cancer keeps growing despite low testosterone levels. The good news is: we now have more tools than ever before.
Immunotherapy, targeted therapy, or radiopharmaceuticals (like Pluvicto) might be options, especially if your cancer has specific genetic changes.
Chemotherapy may still play a role.
Sipuleucel-T, a cancer vaccine, might help if the symptoms are mild.
We may also test your tumor for gene mutations, such as BRCA1 or BRCA2, because certain targeted drugs work incredibly well when these mutations are present.
Clinical Trials: The Next Frontier
If standard options aren’t working, clinical trials offer hope. Many promising new drugs are being tested that could make a real difference.
Final Thoughts
Facing recurrent prostate cancer is never easy. But it’s far from the end of the road. With the right team, the right treatment plan, and ongoing support, there’s always hope—and often, tangible progress. If you’re navigating a recurrence, don’t lose heart. There are options, and there are people ready to fight alongside you.Dr. David Samadiis the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer, Now What? A Practical Guide to Diagnosis, Treatment, and Recovery and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.
