Photo: Anete Lusina

Can prostate surgery be done twice?

The risk of side effects is usually higher when a treatment is used as a second-line treatment than when it's used as your first treatment. This is because your first treatment may have already caused some damage to the tissue surrounding the prostate. Side effects may also be more severe with a second-line treatment.

prostatecanceruk.org - If your prostate cancer comes back

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Which second-line treatments are available to me?

It’s unlikely that all of the treatments will be available to you. Several things affect which treatments are suitable, including:

where your cancer is

your general health

your PSA level and other test results

what treatment you’ve already had.

Where your cancer is

Cancer that has returned in the prostate or the prostate bed is called local recurrence. If you have local recurrence, you might be offered further treatment aiming to get rid of the cancer. Cancer that has spread to the area just outside the prostate, but not to other parts of the body, is called locally advanced recurrence. Some men with locally advanced recurrence will also be offered treatment that aims to get rid of the cancer. But if your cancer has spread to other parts of your body (advanced prostate cancer), then treatment can no longer cure it. You will be offered hormone therapy to control the cancer, rather than getting rid of it. You might also be offered chemotherapy alongside hormone therapy.

Your general health

Your health and any other medical problems will also affect what treatments are available to you. For example, you may already have side effects from the first treatment you had. Having another treatment can cause side effects as well, so you’ll need to be fit enough to cope with this.

Your PSA level and other test results

Your PSA level and how fast it is rising will affect what treatments you are offered. You might have the option of monitoring your PSA level for a while before you have further treatment, particularly if your PSA level is rising slowly. If your PSA level is rising quickly, this suggests your cancer is more likely to have spread further.

What treatment you've already had

If your first treatment was surgery (radical prostatectomy), you might be able to have:

radiotherapy to the prostate bed (with or without hormone therapy)

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hormone therapy alone.

If your first treatment was external beam radiotherapy, you might be able to have: If your first treatment was permanent seed brachytherapy or high dose-rate brachytherapy, you might be able to have: If your first treatment was HIFU (high-intensity focused ultrasound), you might be able to have:

If your first treatment was cryotherapy, you might be able to have:

Speak to your doctor or nurse about which treatments are available to you.

Side effects of second-line treatment

All treatments have side effects. The risk of side effects is usually higher when a treatment is used as a second-line treatment than when it’s used as your first treatment. This is because your first treatment may have already caused some damage to the tissue surrounding the prostate. Side effects may also be more severe with a second-line treatment. And you might still be getting side effects from your first treatment. Ask your doctor or nurse for more information about the possible side effects from the second-line treatments they offer you. Read our treatment pages to find out about side effects from different treatments. Finding out about possible side effects might help you to choose between your different treatment options, or whether you want to have any treatment.

What if I don't want further treatment?

Some men weigh up the advantages and disadvantages and decide they don't want to have second-line treatment for their cancer. Speak to your doctor or nurse if you are thinking about not having further treatment. They may suggest observing your prostate cancer with regular tests. If it starts to cause symptoms then you’re likely to be offered hormone therapy to control the cancer and help relieve symptoms. There are also other treatments to manage symptoms.

prostatecanceruk.org - If your prostate cancer comes back

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