Introduction

Salvage therapy is any treatment given when the first (primary) treatment doesn’t cure the cancer. In prostate cancer, doctors use salvage therapy to “rescue” patients if initial treatment didn’t get rid of all the cancer or if the cancer comes back after a period of time. Prostate cancer is often treatable and curable with surgery or radiation at first, but about one out of four men see their cancer return after initial treatment. Salvage therapy can sometimes cure the cancer in these cases, or at least control it for a long time. It offers a second chance when prostate cancer persists or recurs.

It’s important to understand two scenarios for salvage therapy in prostate cancer: (1) Salvage therapy after primary treatment failure, and (2) Salvage therapy after recurrence. Primary treatment failure means the first treatment (such as surgery or radiation) did not eliminate the cancer – in other words, the cancer didn’t go away from the start. Recurrence means the cancer came back after being in remission or undetectable for some time. In both cases, salvage treatments are used, but the approach may differ. This guide will explain these scenarios, the treatments available in 2025, new therapies in trials, and questions to ask your doctor. We’ll keep the language simple and clear, so patients, family members, and caregivers can understand the options.

Salvage Therapy After Primary Treatment Failure

Primary treatment failure happens when the initial prostate cancer treatment doesn’t fully work. For example, after surgery to remove the prostate, the PSA blood test (which checks for prostate-specific antigen) might stay high or start rising soon, indicating some cancer was left behind. Or after radiation therapy as the first treatment, follow-up tests might show the cancer is still in the prostate. In simple terms, the cancer was not cured by the first treatment. When this happens, doctors turn to salvage therapy as the next step. The goal is to eliminate or control the remaining cancer.

Why is salvage therapy needed in this scenario? If cancer remains after the primary treatment, it can continue to grow or spread. Salvage therapy gives another chance to stop the cancer. It’s often most effective while the disease is still localized (contained in or near the prostate) pmc.ncbi.nlm.nih.gov. Doctors will usually do imaging tests (like MRI or PET scans) and maybe biopsies to locate any remaining cancer cells. If the cancer is thought to be just in the prostate area, a second attempt to cure it might be possible.

Approved salvage treatments after primary failure include:

Salvage Radiation Therapy (SRT): This is radiation given after surgery if cancer cells might be left in the prostate bed (the area where the prostate was). For example, if PSA is rising after a prostatectomy (surgery), doctors can aim high-energy X-rays at the prostate bed to kill remaining cancer. Large studies show that salvage radiation after surgery can improve survival, delay cancer progression, and even offer a second chance at cure for many patients onclive.com. Salvage radiation is typically done as external beam radiation to the prostate area. It works best when the PSA level is still low (early intervention).
Salvage Prostatectomy: This is surgery to remove the prostate (or what’s left of it) after a primary treatment like radiation has failed. If the cancer was first treated with radiation and it didn’t succeed, the surgeon may attempt a salvage radical prostatectomy. This can remove the cancer if it is still confined to the prostate. However, doing surgery after radiation is more challenging and comes with higher risk of side effects like urinary incontinence (trouble holding urine) and erectile dysfunction. The tissues are scarred from radiation, making surgery harder. Doctors will consider this option only for healthy patients when the cancer seems limited to the prostate.
Salvage Ablative Therapies: These are targeted treatments that destroy prostate tumor tissue without full surgery. Examples are cryotherapy (freezing the tumor) or HIFU (High-Intensity Focused Ultrasound). These can be used as salvage methods if radiation was the first treatment and cancer remains in the prostate. Ablative therapies after radiation can sometimes control the cancer with less invasive procedures. However, even these have a higher risk of side effects when done as salvage (for instance, cryotherapy after radiation can also cause urinary or sexual side effects). Sometimes, salvage brachytherapy (implanting radioactive seeds) is considered if the initial treatment was external beam radiation. Doctors choose these local therapies based on tumor location and patient health.
Hormone Therapy (Androgen Deprivation Therapy, ADT): If local treatments (like radiation or surgery) aren’t enough or aren’t possible, doctors often use hormone therapy. Prostate cancer growth is fueled by male hormones (androgens) like testosterone. Hormone therapy uses medications to lower testosterone or block its effect on cancer cells, which makes the cancer shrink or slow down. In a salvage setting, a doctor might recommend ADT if the cancer has spread beyond the prostate or if the PSA is rising quickly even after local salvage attempts. Hormone therapy is systemic (treats the whole body) and can keep the cancer in check for a long time, though it’s usually not a cure by itself if cancer is still present. Newer hormone drugs (like enzalutamide or abiraterone) can be used in addition to standard hormone treatments to further suppress the cancer.
Other Systemic Therapies: Depending on the situation, doctors might consider other drugs that travel through the bloodstream to reach cancer anywhere in the body. These include chemotherapy – powerful drugs that kill fast-growing cells, and newer targeted medicines. Chemotherapy (such as docetaxel) isn’t usually the first salvage treatment unless the cancer is more advanced or not responding to hormone therapy. But it can be used later if needed to reduce the cancer and relieve symptoms. There are also targeted therapy drugs (like PARP inhibitors) for cancers with specific genetic features, and immunotherapy (see below) in certain cases. These systemic treatments are typically considered if local therapies can’t cure the disease or if the cancer has spread.

How do doctors decide on a salvage treatment plan after primary failure? They look at several factors for each patient:

Location of the cancer: Is it likely still in the prostate area only, or has it spread (for example, to bones or lymph nodes)? If it appears confined locally (often indicated by a slowly rising PSA and negative scans for spread), a local salvage (radiation or surgery) is favored for potential long term survival. If there’s evidence the cancer is widespread, systemic therapy like hormones will be prioritized.
Previous treatment type: The kind of primary treatment you had influences the salvage options. For instance, if you already had surgery, you can’t have surgery again to remove the prostate (it’s gone), but radiation is an option. If you had radiation initially, more radiation to the same area is usually not safe (due to tissue damage), so a salvage surgery or other therapy might be considered instead. Doctors basically don’t repeat the same approach if it failed, unless there’s a safe way (like using brachytherapy after external radiation in select cases).
Tumor aggressiveness and PSA behavior: Doctors consider how quickly the PSA is rising and what the cancer’s Gleason score was (a measure of how aggressive the cancer cells looked). Fast-rising PSA after treatment suggests active cancer that may spread soon. In such cases, doctors are more likely to recommend starting salvage treatment early. A higher Gleason score (more aggressive cancer) also pushes for prompt, possibly combined salvage therapies. In contrast, if PSA is rising very slowly and the cancer seemed less aggressive, doctors might monitor a bit longer (with close follow-up) before jumping into a tough salvage treatment. They balance the urgency of cancer control with the risks of treatment.
Patient’s overall health and preferences: The patient’s age, general health, and personal wishes matter. Salvage treatments like surgery or radiation can have significant side effects and recovery time. Not every patient is fit enough for surgery, for example, if they have other serious health issues. Some patients may prioritize quality of life and opt for less aggressive management if the cancer is slow-growing. Doctors use shared decision-making, explaining the pros and cons of each option. They will recommend what they believe is the best approach, but the patient’s comfort with the plan is key. For instance, a man in his 70s with other illnesses and a slowly rising PSA might choose careful monitoring or just hormone therapy, rather than a difficult salvage surgery. On the other hand, a healthy younger man with a local recurrence might pursue an aggressive salvage treatment to try for a cure.

In summary, salvage therapy after primary treatment failure aims to clear any remaining cancer. Options like radiation or surgery (or ablation) are used to target residual local disease, while hormone or systemic therapies address broader disease. Doctors personalize the plan by considering where the cancer is, how aggressive it is, what was done before, and the patient’s health. The sooner the salvage therapy is given (for example, starting salvage radiation when PSA is still low), the better the chances of success. The decisions can be complex, but the goal is to maximize the chance of controlling the cancer while minimizing side effects.

Salvage Therapy After Recurrence

Recurrence means the prostate cancer comes back after a period of time when it was thought to be cured or under control. This could be months or years after the initial treatment. You might have finished treatment and had no signs of cancer for a while (for example, PSA was undetectable), but later the PSA starts rising or scans detect cancer. Recurrent prostate cancer is defined as cancer that returns after you’ve had a treatment aimed at cure. It’s also called a relapse. This is different from primary failure, because in a recurrence there was an interval where the cancer seemed gone or inactive.

Finding out that cancer has returned can be upsetting, but there are many treatments available for recurrent prostate cancer in 2025. The choice of salvage therapy now depends on where the cancer has recurred and what treatments you had before. A recurrence can be local (in the prostate area or nearby) or distant/metastatic (spread to other parts of the body like bones or lymph nodes). Doctors will often use imaging (such as PET/CT or MRI) to see where the cancer is, because that guides the next steps.

If the recurrence is local only (for example, a tumor reappeared in the prostate bed or in one pelvic lymph node), sometimes a local salvage treatment is still possible, similar to the primary failure scenario. For instance, if you originally had surgery and later have a recurrence in the prostate bed, salvage radiation can be used to target that area. If you originally had radiation and the cancer comes back in the prostate gland, a salvage prostatectomy or salvage cryotherapy might be considered to remove or destroy the recurrent tumor. Local salvage for recurrence can potentially cure the cancer or delay spread, and it might let you avoid or postpone long-term drug therapy pmc.ncbi.nlm.nih.gov. However, as noted earlier, salvage surgery after radiation is high-risk, and not all patients qualify for it. Doctors will carefully evaluate if a recurrence is truly confined and if the patient can tolerate another local treatment.

In many cases of recurrence, especially if the cancer has spread beyond the prostate area, systemic treatments(treatments that reach cancer cells throughout the body) become the mainstay of salvage therapy. Here are the approved treatments for recurrent prostate cancer:

Hormone Therapy (ADT): This is usually the first-line salvage treatment for a recurrence, particularly if the cancer has spread. Androgen deprivation therapy is very effective at slowing prostate cancer. It can be done with injections or pills that suppress the body’s production of testosterone (like LHRH agonists/antagonists), or with surgery to remove the testicle source of testosterone (orchiectomy). Often, ADT is started as soon as a rising PSA or scans show that cancer is back and not curable by local means. Hormone therapy is usually the preferred treatment when prostate cancer has spread to other parts of the body. It can shrink tumors and relieve symptoms, and many men stay on hormone therapy for years. It’s important to note that while hormone therapy can put the cancer into remission, it usually doesn’t cure metastatic cancer – cancer cells may survive at a low level and can eventually grow again if they become resistant to the hormones. For this reason, doctors sometimes refer to this stage as palliative (to control disease and symptoms) rather than curative. However, hormone therapy can prolong life and keep the cancer in check for a long time. Newer hormone medicines (often called androgen receptor inhibitors or next-generation ADT) can be added to standard hormone therapy to improve control. These include drugs like enzalutamide, apalutamide, abiraterone, or darolutamide – often used if the cancer is high-risk or if it progresses despite initial hormone shots. In short, for recurrent prostate cancer, especially metastatic, hormone therapy is usually the backbone of treatment.
Chemotherapy: Chemotherapy uses strong medicines that kill cancer cells or stop them from growing. In prostate cancer, chemo is commonly used when the disease becomes resistant to hormone therapy or is very aggressive. A standard chemo drug for prostate cancer is docetaxel, which has been shown to help men live longer in advanced stages. Sometimes docetaxel is even used earlier in combination with hormone therapy for men with widespread disease, based on clinical studies. Another chemo drug, cabazitaxel, can be used if the cancer progresses after docetaxel. Chemotherapy is given in cycles through an IV. For recurrent cancer that’s metastatic, chemo is considered if the cancer is growing despite hormone treatments or if it’s causing significant symptoms. While chemo can have side effects (like fatigue, hair loss, low blood counts), it can reduce tumor size and pain. In a salvage context, adding chemotherapy to hormone therapy has been shown to improve outcomes for some patients with advanced recurrent prostate cancer. However, chemo is usually not used if the cancer is only locally recurrent and other options exist, because chemo is reserved for systemic disease. It’s one of the tools doctors use when prostate cancer becomes more aggressive or widespread.
Immunotherapy: Immunotherapy helps your own immune system fight the cancer. One FDA-approved immunotherapy for prostate cancer is a vaccine called sipuleucel-T (Provenge). It’s not a vaccine to prevent cancer, but rather a treatment made from your immune cells, designed to attack prostate cancer cells. Sipuleucel-T is used for men with advanced prostate cancer that is no longer responding to hormones but is causing minimal or no symptoms. It has been shown to help men live longer by boosting the immune response to the cancer. It doesn’t typically lower the PSA or shrink tumors like chemo does, but it can prolong survival. Other forms of immunotherapy, like checkpoint inhibitor drugs (e.g., pembrolizumab), have a role only for certain prostate cancers with specific genetic traits (such as MSI-high or dMMR tumors, which are uncommon in prostate cancer). These are being tried in clinical trials or special cases. In 2025, immunotherapy is not the main salvage treatment for most prostate cancer patients, but it’s an important option for some. Researchers are also testing new immunotherapies, including CAR T-cell therapies (engineered immune cells) and other cancer vaccines, in clinical trials for prostate cancer. Immunotherapy offers a different approach: instead of attacking the tumor directly (like radiation or chemo), it trains the body to do the attack.
Targeted Therapy: Targeted therapies are drugs that target specific characteristics of cancer cells, often based on genetic mutations. Prostate cancers sometimes have mutations in genes that help repair DNA (such as BRCA1 or BRCA2). If a recurrent prostate cancer has one of these mutations (doctors may do genomic testing on a biopsy or blood sample to find out), it might be treated with a type of targeted drug called a PARP inhibitor. Examples are olaparib or rucaparib, which have been approved for prostate cancer with BRCA or similar mutations. These drugs can slow the cancer’s growth by exploiting the cancer cells’ impaired DNA repair mechanism, causing them to die. Targeted therapies are usually pills and are used for advanced cancer that has progressed after other treatments. Another form of targeted therapy is radioisotope therapy like radium-223 (which targets bone metastases) or the newer PSMA-targeted radioligand therapy. PSMA-targeted therapy is a newer type of treatment where a radioactive molecule seeks out prostate cancer cells (by targeting a protein called PSMA on the cancer cell surface) and delivers radiation directly to them. An example is lutetium-177 PSMA (Lu-177 PSMA) therapy, which in trials showed improved outcomes for metastatic prostate cancer and is becoming more widely available. This kind of treatment is used when cancer has spread and other options like hormone therapy aren’t working well. It’s quite specialized but represents how precision medicine is being applied to prostate cancer. In summary, targeted therapies “find and attack” cancer cells with certain markers, and they are typically reserved for recurrent or advanced cases with those specific markers.

Choosing salvage therapy after recurrence depends on disease stage and prior treatments. Doctors will ask: Where has the cancer returned? If it’s only in one area, a local therapy might be attempted for cure (for example, radiation to a single lymph node or a surgery to remove a local tumor). If the cancer is already spread to multiple spots, local therapy alone won’t be enough, so systemic treatments (hormones, chemo, etc.) are used pmc.ncbi.nlm.nih.gov. They also consider what you’ve had before. If you never had radiation but had surgery initially, and now cancer is back in the prostate bed, radiation can be used now (salvage radiation). If you never had hormone therapy before, hormone therapy will almost certainly be started with a recurrence because the cancer likely still responds to it. On the other hand, if you’ve already been on hormone therapy and the cancer became resistant (a state called castration-resistant prostate cancer, CRPC), then the salvage strategy might skip straight to second-line hormone drugs, chemo, or a clinical trial of a new agent. The prior treatments also affect side effect considerations: for example, if you had full-dose pelvic radiation before, doctors might avoid another radiation to that area due to toxicity and choose a drug therapy instead

Stage of disease is critical:

If the recurrence is non-metastatic (localized), doctors may pursue an aggressive approach for a possible cure. This could mean salvage radiation to the prostate bed or other area of recurrence, possibly combined with short-term hormone therapy to increase effectiveness. In some cases of a single metastatic spot (oligometastasis), targeted radiation (stereotactic body radiotherapy) to that spot may be done as well, to delay progression.
If the recurrence is metastatic, the treatment goal shifts from cure to control. Hormone therapy is started (if not already), and often patients receive a combination (for example, ADT + abiraterone, or ADT + chemotherapy) for stronger effect. The stage also influences timing: high-volume aggressive metastatic disease might prompt immediate multi-modal therapy, whereas low-volume might be managed stepwise.

In summary, salvage therapy for recurrent prostate cancer is highly personalized. Many of the same treatments used initially can be used again as “second-line” or salvage treatments – for example, surgery, radiation, hormones – but applied based on the situation. The key difference is that after a recurrence, doctors often rely more on systemic therapies(because recurrence can indicate micrometastatic disease even if scans are clear). The encouraging news is that in 2025 there are multiple effective options to manage recurrent prostate cancer, and ongoing research is adding even more tools.

Emerging Salvage Therapies in Clinical Trials

Research in prostate cancer is very active, and new salvage therapies are being studied in clinical trials. These emerging treatments aim to improve outcomes when standard salvage options are not enough. Here are some new or experimental approaches on the horizon:

New Drug Combinations and Intensified Therapy: Clinical trials are testing whether adding more treatments upfront can improve salvage therapy success. For example, studies are looking at combining hormone therapy with newer hormone-blocking drugs and chemotherapy at the time of salvage radiation for high-risk patients onclive.com. One trial approach gave men with recurrent PSA after surgery a combination of ADT (hormone shots), an AR inhibitor (like apalutamide), plus salvage radiation and even chemotherapy, to see if this intensive approach can cure more men. Early results suggest that some combinations can delay progression, but doctors are still figuring out the best balance of effectiveness and side effects. By 2025, it’s not standard to give chemo during salvage radiation for non-metastatic recurrence (guidelines actually advise against adding chemo in that setting), but trials continue to refine these strategies for subsets of patients.
PSMA-Targeted Radioligand Therapy: We mentioned PSMA-targeted therapy as a new targeted treatment. It’s an emerging option in trials for earlier use. [^PSMA]^ Pluvicto™ (lutetium-177 PSMA-617) is a radioligand therapy that was approved for advanced prostate cancer after other treatments. Now, clinical trials are exploring if such PSMA-targeted therapies can be used sooner in the salvage setting. For example, a trial might test Lu-177 PSMA in men with recurrent prostate cancer who have only a few metastases, to see if it can eradicate those and prolong remission. PSMA-targeted therapy is a form of molecular radiation – it delivers radiation precisely to prostate cancer cells by homing in on the PSMA protein. It represents a cutting-edge approach that might become more common in the next few years as studies determine how well it works as a salvage treatment.
Enhanced Immunotherapy: Scientists are working on boosting the immune system further against recurrent prostate cancer. One avenue is checkpoint inhibitors (drugs that help immune cells attack tumors) in combination with other therapies. While checkpoint drugs alone haven’t been very effective in typical prostate cancer, trials combining them with hormone therapy or radiation (which might make the tumor more visible to the immune system) are underway. Another exciting area is CAR T-cell therapy – taking a patient’s T-cells (a type of immune cell), genetically engineering them to attack prostate cancer cells, and infusing them back. Early CAR T trials in prostate cancer have shown some promise in killing cancer cells cityofhope.org, but this is still experimental. Researchers are also exploring different targets for immunotherapy, like a vaccine that targets PSA or other prostate proteins, aiming to prevent the cancer from coming back after initial treatment. These approaches are mostly in Phase I or II trials (early-phase studies to test safety and dosing), but they could revolutionize salvage treatment in the future if successful.
Focal Salvage Therapies with Advanced Technology: For men with localized recurrence, new technologies are making focal treatments safer and more effective. High-definition imaging (MRI, PSMA PET scans) can pinpoint small areas of recurrence better than before pmc.ncbi.nlm.nih.gov. This allows doctors to perform focal salvage ablation – treating just the tumor spot instead of the whole prostate area – which can reduce side effects. There are trials of MRI-guided focal HIFU and cryotherapy that precisely target the recurrent tumor while sparing normal tissue. Another novel approach being studied is irreversible electroporation (IRE), sometimes called NanoKnife, which uses electrical pulses to destroy cancer cells in the prostate with minimal heat, potentially useful as salvage after radiation pmc.ncbi.nlm.nih.gov. Early results show these methods can control a local recurrence with fewer urinary side effects than salvage whole-gland surgery. However, long-term data are still needed. Patients interested in these could look for clinical trials at specialized centers.
Genetic and Personalized Therapy: Researchers are learning that prostate cancers have subtypes. Trials are testing drugs that target specific molecular features. For example, PARP inhibitors (mentioned earlier) are now standard for BRCA-mutated cases, but trials are checking if they help other patients in combination with hormone therapy. There’s also research on AKT inhibitors for cancers with a PTEN mutation, and other targeted agents that might be combined with salvage therapy. While these are not yet standard, the hope is that a personalized salvage plan can be developed for each patient’s cancer based on genetic testing of the tumor.

Given these emerging therapies, patients with recurrent prostate cancer might consider enrolling in a clinical trial. But what exactly is a clinical trial and how do they work? Clinical trials are research studies that test new treatments or new ways of using existing treatments. They go through phases:

In Phase I, a small number of patients receive the experimental treatment to evaluate safety and find the right dose.
If it seems safe, it moves to Phase II, where more patients try it to see if it works against the cancer.
Then Phase III trials compare the new treatment to the standard treatment in a larger group, to see if it’s better or has fewer side effects. By the time a treatment gets to Phase III, it has shown promise.
If Phase III is successful, the new treatment may get FDA approval and become a standard option. Sometimes there’s a Phase IV after approval to continue monitoring long-term effects.

Patients in trials are closely monitored and can often get access to cutting-edge therapies before they are widely available. All trials have an Informed Consent process, where doctors explain the potential risks and benefits and you agree (or decline) to participate. Your rights are protected – you can leave the trial at any time, and there are oversight boards ensuring ethical conduct. Many patients choose trials not only for potential personal benefit but also to help advance science.

Tips for working with clinical trial investigators (the doctors and research team running the study):

Ask questions and stay informed: Don’t hesitate to ask the trial doctor, “Why is this trial being done? What is the goal of the treatment being tested? What kinds of tests and visits are involved? How might it help me, and what are the risks?” Knowing the purpose and procedures will help you feel more comfortable. The research team is there to answer these questions – they want you to be informed.
Communicate openly: Once in a trial, tell your research team about any symptoms or side effects you experience. Even if something seems minor, it could be important. The investigators need accurate information to evaluate the treatment’s safety. Also, discuss any other medications or supplements you’re taking, since they might affect the trial treatment.
Follow instructions carefully: Trials often have specific schedules for medication doses, clinic visits, scans, and blood tests. It’s important to follow these as closely as you can, because the data need to be collected in a certain way. If you’re unsure about any instructions (for example, how to take a pill or prepare for a scan), ask the coordinators or nurses for clarification.
Keep support people in the loop: It may help to bring a family member or friend to your appointments. They can help you keep track of information and schedule, and provide emotional support. Having someone else hear the explanations can ensure you don’t miss anything. They might also help you remember to report things or ask questions you wanted to ask.
Stay engaged and proactive: Remember, being in a trial is voluntary. You are part of the team searching for a better treatment. If you feel the trial isn’t right for you at any point, discuss it with the doctors. And if you decide not to participate or to withdraw, your doctor will continue to treat you with the best known therapies. There’s no harm in exploring trials – even if you don’t join one, you’ll learn more about your options.

In summary, emerging salvage therapies are bringing hope beyond the traditional methods. From new drug cocktails, targeted radiation like PSMA therapy, to advanced immunotherapies and focal treatments, the landscape is continually improving. Clinical trials are the pathway for these innovations to become mainstream. If your prostate cancer situation is suitable, being in a trial might give you access to the latest treatments and expert care. Always discuss with your doctor whether there’s a trial that fits your needs, and weigh the potential benefits and risks. The field is evolving, and what’s experimental today could become tomorrow’s standard salvage therapy.

Questions to Ask Your Doctor

When facing a prostate cancer recurrence or salvage therapy decision, it’s crucial to have open conversations with your healthcare team. Here are some key questions you might ask your doctor:

Where is the cancer now? Do we know if my cancer is confined to the prostate area, or has it spread somewhere else? (Understanding this will guide the treatment choices.)
What salvage treatment options do I have? Can we try surgery, radiation, hormone therapy, or other treatments in my case? Which do you recommend, and why?
What is the goal of this treatment? Are we aiming to cure the cancer, or to control it and slow it down? How will this treatment help me in the short term and long term?
What are the possible side effects or risks? For the treatment you suggest, what side effects should I be prepared for (short-term and long-term)? How might it affect my daily life, and are there ways to manage these side effects?
How will we know if the salvage therapy is working? How often will I have check-ups or PSA tests/imaging after starting treatment? What should we expect the PSA to do? What is our plan if the PSA doesn’t go down or if the cancer doesn’t respond?
Are there other options if this treatment doesn’t work? If the first salvage approach isn’t successful, what would we do next? (It’s comforting to know there’s a Plan B or C.)
Should I consider a clinical trial or second opinion? Is there a clinical trial that might be appropriate for me, given my situation? Would it be helpful to talk to a specialist (like a medical oncologist or radiation oncologist if I haven’t yet) about other perspectives on my case?
How urgent is it to start salvage therapy? Do we need to begin treatment right away, or do I have time to consider options and possibly get another opinion? What happens if we delay treatment for a little while?

These questions will help you gather the information needed to make an informed decision. Remember, no question is too small – if something is unclear, ask for clarification. Your doctor understands that this is a challenging time and should be willing to explain things in a way that makes sense to you. Bring a notepad or have a family member with you when discussing these points, so you can remember the answers later. The more you understand your options, the more confident you’ll feel in the path you choose.

References

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Prostate Cancer UK. If Your Prostate Cancer Comes Back (Recurrent Prostate Cancer). prostatecanceruk.org. [Accessed 2025 Mar 2].
Hollasch M. New Clinical Practice Guideline Provides Overview on Salvage Therapy’s Role in Prostate Cancer. OncLive. 2024.
Deivasigamani S, et al. Evaluation of Recurrent Disease after Radiation Therapy for Patients Considering Local Salvage Therapy: Past vs. Contemporary Management. Cancers (Basel). 2023;15(24):5883.
Cleveland Clinic. PSMA-Targeted Therapy: Purpose & Results. ClevelandClinic.org Health Library. 2023.
American Cancer Society. Treating Prostate Cancer That Doesn’t Go Away or Comes Back – Advanced Therapies. Cancer.org. 2023.