Subsequent statements are based on the current S3 guideline unless otherwise noted.
Recurrence estimated to be locally confined
- In patients with PSA recurrence and favorable prognostic criteria, wait-and-see is an option.
- HIFU therapy (high-intensity focused ultrasound; High-Intensity Focused Ultrasound, HIFU) can be used for the therapy of histologically (fine tissue) confirmed isolated local recurrence (local recurrence of cancer) after percutaneous radiotherapy (irradiation “from the outside”).The patient should be informed about the experimental nature of this procedure as salvage therapy (“rescue therapy”) and about the therapy alternatives.
PSA recurrence and PSA persistence after radical prostatectomy
- Percutaneous salvage radiotherapy (SRT) (min 66 Gy) should be offered as a treatment option after radical prostatectomy (surgical removal of the prostate with capsule, the terminal segments of the vas deferens, and the seminal vesicles) for PSA rise from the zero range in the pN0/Nx category.
- SRT should be started as early as possible (PSA before SRT < 0.5 ng/ml).
PSA progression after radiotherapy
- Salvage prostatectomy (removal of the prostate after primary radiotherapy) is a treatment option for PSA recurrence after primary percutaneous radiotherapy or brachytherapy (internal radiation therapy) when PSA progression is highly unlikely to be due to metastasis.
- Bioptic confirmation should be sought before salvage prostatectomy.
PSA recurrence and progression
- Hormone ablative therapy (also called ADT = androgen deprivation therapy; hormone therapy that withholds the male sex hormone testosterone) is not standard therapy for PSA recurrence or progression.
- On the topic of hormone ablative therapy for metastatic prostate cancer, see under “Drug Therapy.”
Further notes
- In patients with T2/T3N0 tumors and PSA recurrence who received radiotherapy (64.8 Gy; spread over 36 appointments) followed by 12 months of bicalutamide (nonsteroidal and selective antiandrogen; 150 mg/die), 76.3% of patients were still alive after 12 years (versus 71.3% with radiotherapy alone). Prostate cancer-specific mortality was 13.4% with radiotherapy alone and only 5.8% after additional hormone therapy.
