Salvage Therapy for Prostate Cancer

Biochemical recurrence after treatment of prostate cancer occurs in 30–50 % of patients. Confirming that recurrence is localized to the pelvis is challenging as PSA is nonspecific and imaging modalities are imperfect in identifying location of recurrent disease. Salvage therapy after radical prostatectomy is limited to external beam radiotherapy and androgen-deprivation therapy. After radiotherapy, local salvage therapy consists of salvage radical prostatectomy, salvage brachytherapy, and salvage high-intensity ultrasound. Each treatment modality provides various rates of cure but with its own side-effect profile, prompting discussion between patient and clinician to determine appropriate treatment course. Local salvage therapy has the potential to be curative and disease control has been reported in a substantial number of select patients. However, the survival benefit of these therapies has yet to be definitively proved.