Recurrent prostate cancer following external beam radiotherapy: Follow-up strategies and management

A sound follow-up strategy after radical radiotherapy (RT) for localized prostate cancer is needed to improve individual treatment results by providing accurate information about local relapse and complication rates. In addition, early detection of recurrence provides opportunities for re-treatment and salvage of a local or systemic relapse. Prostate-specific antigen (PSA) level determination is the mainstay of post-RT follow-up, and periodic measurement of post-RT PSA kinetics is the established surrogate method of determining post-RT outcome and should be continued for life. Posttreatment sextant biopsies performed 2 to 3 years after. RT provide pathologic evidence of local tumor control and a positive posttreatment biopsy is a must before considering local ablative salvage therapy. Although hormonal therapy remains the standard treatment of clinical or biochemical relapse following radical RT, local salvage therapy given with curative intent should be considered in selected individuals with biopsy-proven local relapse.