Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-Metastatic Biochemical Recurrence After Primary Radical Prostatectomy

The guideline provides recommendations for managing non-metastatic biochemical recurrence (BCR) of prostate cancer after primary radical prostatectomy, emphasizing the addition of androgen deprivation therapy (ADT) to salvage radiotherapy (RT) for patients with high-risk features. Evidence from three randomized trials (GETUG-AFU 16, RTOG 9601, and NRG/RTOG 0534 SPPORT) supports the benefit of ADT in improving progression-free survival, metastasis-free survival, and overall survival. However, ADT is associated with increased risks of adverse events such as diabetes, heart disease, and bone density loss. The guideline advises against adding docetaxel to salvage RT and ADT due to lack of benefit and increased toxicity and suggests that intensified androgen receptor suppression should be used only within clinical trials. For patients without high-risk features, salvage RT alone may be sufficient. The importance of discussing treatment side effects and the impact of medical comorbidities with patients is also highlighted.