A prostate cancer recurrence can feel like the ground shifting under your feet. Whether it's a rising PSA after a period of stability, or new symptoms that lead to further tests, it can be confronting. For some men, it occurs soon after their initial treatment finishes, while for others it may occur many years later.
Here are some practical steps you can take to help navigate the challenges of a re-diagnosis.
Coping with the emotional impact
Shock, fear, anger, and grief often arrive in waves. Give yourself permission to feel those emotions without rushing every decision. Many people find it helpful to name specific worries - survival, side effects, work, intimacy, finances - and share them with their care team and a trusted friend or partner. Turning dread into concrete questions can help make planning easier.
Seeking professional support, such as counselling, can also help manage spiralling thoughts and decision fatigue, while simple daily practices like a ten-minute walk, breathing exercises, or mindfulness, can help steady the nervous system.
PCFA has a team of experience counsellors available at no cost to help you navigate the emotional challenges of a diagnosis, simply click here to find out more.
Understanding treatment options
What happens next depends on the clinical aspects of your recurrence, treatments you've already had, and what the imaging and test results show.
The encouraging news is that there are many effective treatments for recurrent prostate cancer, and plenty of new and emerging therapies that will become available over the weeks and months ahead.
These treatments can help control the growth of your cancer, manage your symptoms, and extend your life expectancy, without necessarily diminishing your quality of life.
If you experience local recurrence after surgery, within the prostate fossa, or bed, salvage radiotherapy is usually recommended, sometimes in combination with hormone therapy, to further reduce the likelihood of any ongoing spread. This is usually indicated after the PSA level rises above 0.2ng/ml, and is usually informed by a PSMA PET scan to try and identify any small cancer cells in surrounding areas of the body, which can help guide radiotherapy.
If you experience local recurrence following initial treatment with radiotherapy, your options may include salvage prostatectomy or possibly focal therapies, depending on your situation, but more common treatment approaches are androgen deprivation therapy, which is also known as hormonal therapy. Recurrence after radiotherapy is usually defined as a PSA rising 2.0ng/ml above its lowest point following the radiotherapy. Again, PSMA PET imaging is performed to guide treatment decision making.
If you experience recurrence when living with advanced or metastatic disease, your cancer cells may have become resistant to particular forms of therapy, causing your PSA levels to rise over time, and new metastases may appear on imaging. You might also develop new symptoms, such as increased fatigue, weight loss, or an increase in pain. In situations such as this, your treatment will largely depend on where the cancer is located and anything else we can learn about the nature of your specific cancer cells.
For some men this may involve further targeted radiation, medications such as hormone therapy, genetic testing to determine suitability for targeted medicines, or other newer radioligand therapies or clinical trials.
It's important to discuss your treatment options with a PCFA specialist nurse and your clinical team, so that you're made aware of any side effects, and how the cancer will be monitored. Understanding your treatment goals and having an awareness of the potential impacts can help with decision making and allow you to seek necessary support, easing some of the distress that is so often associated with news of recurrence.
Building a strong support system
Your clinical team may include your urologist and a radiation or medical oncologist, with a Prostate Cancer Specialist Nurse to support your understanding, assist with side‑effect management and coordination. Your GP will also remain a part of your care team, ensuring your general health and wellbeing is managed alongside the specialist cancer care.
Many people also benefit from an exercise physiologist and pelvic health physiotherapist. Evidence shows that an individualised and structured exercise program is important in reducing treatment side effects and improving your physical and cognitive function, as well as your psychological wellbeing.
A psychologist or counsellor can also help with adjusting to a recurrence or a fear of a further recurrence, as well as helping you to manage changes in mood, anxiety, sleep, relationship strain, and issues concerning your identity and sense of self. If money and work are on your mind, a social worker or financial counsellor can help you plan any necessary leave, navigate insurance, and understand potential costs.
Tapping into peer and family support
Local prostate cancer support groups and telephone-based services, like PCFA's MatesCONNECT program, can connect you with people who have been through a similar experience and provide you with practical tips and reassurance that your feelings are normal.
You can find a local support group here: www.pcfa.org.au/support/find-a-support-group or connect with other through MatesCONNECT or PCFA's Online Community.
Preparing for decisions and next steps
It's helpful to ask for copies of pathology reports and imaging, and to request a plain‑language summary of your situation and options. Also consider taking a list of questions to consultations, asking about expected benefits and risks, any impacts on your sexual and urinary function, timelines and recovery, costs, and what happens if the first plan doesn't work.
After each appointment, take a moment with a partner or friend to summarise what you heard. PCFA's Prostate Cancer Specialist Nurses can also help you navigate this process and get the right information from your clinical team.
Where to get help
