Unfortunately, some men will have recurrent prostate cancer after treatment for localized prostate cancer. This is typically found during follow-up due to a rising PSA. PSA can be more valuable after initial treatment in detecting a recurrence (especially in men who were first treated with surgery). The best treatment options for a rising PSA depends on the overall initial cancer characteristic and the location of suspected recurrence. The importance of having access to state-of-the-art imaging (MRI, PSMA and PET CT) is critical to determine if the cancer has returned locally or distantly as this will impact treatment.
Here are UCLA we often a combination of MRI, PSMA and Axumin to determine the precise location of cancer recurrences. This helps our multidisciplinary treatment teams determine the next best treatment options.
Some men will benefit from surgery after radiation if the recurrence is localized to the prostate. This is a very technically challenging operation and requires significant expertise to perform safely. Our surgeons at UCLA have extensive experience performing these surgeries and most often performed with robotic assistance. This procedure is called salvage prostatectomy and is most frequently performed by Dr. Robert Reiter. We also have extensive experience in utilizing HIFU and cryotherapy in men that require salvage therapy after radiation but are not able to undergo surgery.
In men who were initially treated with surgery, if there is a rise in the PSA and a local recurrence, often radiation therapy is used. Our urologists work very closely with radiation oncologists to determine when to treat patients with salvage radiation, including for nodal recurrences. Utilizing MRI and PSMA imaging, allows us to provide treatment directly to the site of recurrence. Our surgeons also perform salvage pelvic node dissections using PSMA guidance to do the surgery via a clinical trial protocol.