Treatment Options in Prostate Cancer Once Primary Therapy Fails

A significant proportion of patients with prostate cancer experience biochemical failure following primary therapy. Of these, some may be at high risk of dying from prostate cancer. Salvage therapy can improve survival outcomes in these patients but at the cost of adverse effects that may affect quality of life. The choice of salvage therapy depends on the location of the tumour recurrence and how aggressive the disease is. This article examines the treatment options for patients with a rising prostate-specific antigen (PSA) level after radical prostatectomy or radiotherapy, using two clinical scenarios. After radical prostatectomy fails, radiotherapy is a salvage option for low-risk patients with local disease recurrence; however, hormonal therapy, with or without radiotherapy, may represent a better option for patients with high-risk disease. Local salvage therapy options in patients with PSA failure after radiotherapy include brachytherapy, cryotherapy, high-intensity focused ultrasound, and surgery. In patients with moderate- to high-risk disease, most clinicians would also prescribe some form of hormonal treatment.