Prostate Cancer Recurrence After Radiotherapy
What is a Prostate Cancer Recurrence?
External Radiotherapy is one of the most commonly used treatments for localized prostate cancer, showing good outcomes in most cases. However, in some patients, cancer cells may reappear months or even years after treatment, a condition known as prostate cancer recurrence.
Approximately 40% of men who have faced an initial prostate cancer diagnosis may experience a recurrence of the disease over time.
Prostate cancer recurrences can be local, when the tumor reappears in the prostate (or in the same area if the prostate has been removed); regional, when it affects nearby tissues or lymph nodes close to the original tumor site; and distant, when metastases develop in distant areas of the body.
The causes of prostate cancer recurrence may be related to cancer cells' resistance to initial treatment or the inability of the treatment to eliminate all malignant cells. When this occurs, it is crucial to start a new treatment plan aimed at eliminating or controlling the tumor cells with minimal functional impact on the patient.
Symptoms of Prostate Cancer Recurrence
After initial prostate cancer treatment, patients should attend follow-up appointments and undergo monitoring tests, such as PSA testing, to track their progress.
One of the warning signs of prostate cancer recurrence is a PSA elevation in three consecutive assessments. However, since other factors may also cause elevated PSA levels, a more in-depth and personalized diagnosis is always necessary.
In the vast majority of cases, prostate cancer recurrence is asymptomatic, meaning it does not cause any noticeable symptoms. However, some urinary and non-urinary symptoms may be associated with a possible recurrence:
- Sudden and urgent need to urinate
- Burning sensation or discomfort while urinating
- Involuntary leakage of urine drops after finishing urination
- Difficulty starting urination, even when feeling the urge
- Pressure or discomfort in the lower abdomen
- Feeling that the bladder is not completely empty after urination
- Increased urinary frequency, especially at night
- Reduced urinary stream strength and intermittent flow
- Lower back pain or bone pain in other areas
- Fatigue and persistent tiredness
Diagnosis of Prostate Cancer Recurrence
An increase in PSA (Prostate-Specific Antigen, PSA) is often the first sign of prostate cancer recurrence. To confirm the diagnosis and determine the extent of the recurrence, advanced imaging tests and, in some cases, biopsy are required.
The most commonly used diagnostic tests include:
- Pelvic or Prostate MRI (Magnetic Resonance Imaging): Identifies suspicious areas in the prostate or prostate bed.
- PET-PSMA with CT (Positron Emission Tomography with Prostate-Specific Membrane Antigen): A high-precision scan that detects tumor cells at early stages.
- CT Scan (Computed Tomography): Evaluates the presence of tumor masses and enlarged lymph nodes.
- Bone Scintigraphy: Detects bone metastases using a radioactive tracer.
- Prostate Biopsy: Confirms the presence of cancer cells, if necessary.
Best treatments for Prostate Cancer Recurrence after Radiotherapy
When prostate cancer recurrence occurs after external radiotherapy, several treatment options are available. One possibility is salvage surgery, but this approach carries the typical risks of any general anesthesia surgery, such as bleeding or infection. Additionally, it is associated with significant complications, including urinary incontinence, erectile dysfunction, and rectal fistulas, as well as longer hospitalization, catheterization, and recovery periods.
The most modern and recommended techniques are Cryotherapy and Brachytherapy, both focal and whole-gland approaches. These methods minimize both local and systemic side effects, have a shorter recovery time, and offer outcomes equal to or superior to surgery. While complications may occur, as with any treatment, their frequency is lower (e.g., lower rates of incontinence and erectile dysfunction).
Unfortunately, many patients with prostate cancer recurrence are not offered these advanced techniques and are instead treated with hormone therapy (androgen deprivation therapy, ADT)—a method that blocks the action and activity of testosterone. While effective, this approach can cause significant systemic side effects, including sexual dysfunction, depression, fatigue, osteoporosis, and muscle loss.
At the Prostate Institute, we are one of the few institutions in Portugal offering these advanced techniques and personalized treatments tailored to each patient's specific case.
Want to learn more about these treatments?
What is the post-treatment process for Prostate Cancer Recurrence?
After treatment for prostate cancer recurrence, medical follow-up becomes a crucial pillar in ensuring treatment effectiveness and managing potential side effects. In the first few years, monitoring is more frequent, including regular PSA assessments, additional diagnostic tests, and continuous support, allowing the patient to feel safe and well-guided throughout recovery.
Local treatments, such as Cryotherapy and Brachytherapy, are the preferred options, as they target the tumor without affecting the entire body. Compared to surgery or hormone therapy, these approaches better preserve the patient's quality of life.
Although less invasive, these treatments may cause temporary side effects, including increased urinary frequency, burning sensation during urination, and, in some cases, mild to moderate urinary incontinence or erectile dysfunction.
Every patient is unique, so continuous and personalized follow-up is essential to achieve the best balance between disease control and overall well-being.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
Frequently asked questions about Prostate Cancer Recurrence
How can I know if my prostate cancer recurrence is curable?
What are the side effects of prostate cancer recurrence treatment?
If I have a recurrence, does that mean prostate cancer is no longer curable?
How long does it take for a prostate cancer recurrence to appear?
Do all PSA increases indicate a prostate cancer recurrence?
If prostate cancer returns, will it be more aggressive than the initial tumor?
Is it possible to prevent prostate cancer recurrence after external radiotherapy?