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Background <p>Patients who have undergone radical prostatectomy (RP) for prostate cancer (PCa) are at risk of tumor recurrence depending on their individual risk situation. Early indications of this are persistence or a&#xa0;renewed increase in prostate-specific antigen (PSA) levels. Modern imaging (prostate-specific membrane antigen positron-emission tomography–computed tomography, PSMA-PET-CT) is increasingly used to clinically exclude regional or distant metastases prior to individualized multimodal therapy.</p> Objective <p>This article comprises an evaluation and summary of current recommendations for localized tumor recurrence without evidence of regional or distant metastases.</p> Methods <p>A&#xa0;selective literature search was performed, including compilation of relevant publications and references to guidelines.</p> Results <p>Non-metastatic local recurrence is treated with curative normofractionated salvage radiotherapy (SRT) of the prostate bed. Imaging can be used to visualize the current tumor extent, so that an improvement in oncological outcome can be achieved through increased treatment safety. Modern radiation techniques (intensity-modulated radiotherapy, IMRT; image-guided RT, IGRT) render SRT well tolerated and less toxic. Salvage radiotherapy should be administered early after confirmed PSA persistence or a&#xa0;rise from the zero range. Shorter hypofractionated treatment concepts presumably lead to increased intestinal toxicity. The use of concomitant antiandrogen therapy has not been conclusively clarified. The primary intention is exhaustion of local treatment options before starting systemic therapy alone.</p> Conclusion <p>Modern diagnostic and radiotherapeutic procedures enable patients with tumor progression after RP to have a&#xa0;second chance of cure or lasting delay in progression.</p>

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Salvage-Strahlentherapie nach radikaler Prostatektomie

  • 期刊论文

  • 发表日期：

    2025年7月10日

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  • Reinhard Thamm,
  • Angelika Borkowetz,
  • T. Wiegel

摘要

Background

Patients who have undergone radical prostatectomy (RP) for prostate cancer (PCa) are at risk of tumor recurrence depending on their individual risk situation. Early indications of this are persistence or a renewed increase in prostate-specific antigen (PSA) levels. Modern imaging (prostate-specific membrane antigen positron-emission tomography–computed tomography, PSMA-PET-CT) is increasingly used to clinically exclude regional or distant metastases prior to individualized multimodal therapy.

Objective

This article comprises an evaluation and summary of current recommendations for localized tumor recurrence without evidence of regional or distant metastases.

Methods

A selective literature search was performed, including compilation of relevant publications and references to guidelines.

Results

Non-metastatic local recurrence is treated with curative normofractionated salvage radiotherapy (SRT) of the prostate bed. Imaging can be used to visualize the current tumor extent, so that an improvement in oncological outcome can be achieved through increased treatment safety. Modern radiation techniques (intensity-modulated radiotherapy, IMRT; image-guided RT, IGRT) render SRT well tolerated and less toxic. Salvage radiotherapy should be administered early after confirmed PSA persistence or a rise from the zero range. Shorter hypofractionated treatment concepts presumably lead to increased intestinal toxicity. The use of concomitant antiandrogen therapy has not been conclusively clarified. The primary intention is exhaustion of local treatment options before starting systemic therapy alone.

Conclusion

Modern diagnostic and radiotherapeutic procedures enable patients with tumor progression after RP to have a second chance of cure or lasting delay in progression.