When prostate cancer recurs after surgery or radiation, treatment decisions become more complex.
While preventing prostate cancer recurrence remains a central goal of initial treatment and follow-up, recurrence can still occur, even under optimal conditions, requiring carefully considered treatment strategies.
In this post, we explore when treatment for recurrent prostate cancer is appropriate, how modern focal therapies differ from conventional salvage approaches, and how treatment decisions are guided as recurrence becomes clearer through imaging and careful evaluation.
Why Treatment Varies in Recurrent Prostate Cancer
When prostate cancer returns after surgery or radiation, it does not behave the same way as cancer at first diagnosis. Prior treatment alters the prostate bed and surrounding structures, which affects how recurrence appears on imaging and how it can be safely treated.
How recurrent prostate cancer is treated depends on a few key factors:
- Where the cancer has returned
- How the recurrence was identified and confirmed
- How quickly PSA levels are increasing (including PSA doubling time)
- What treatment was used the first time
- How important it is to preserve urinary control and sexual function
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Confirming Recurrent Prostate Cancer Before Treatment
Before determining a treatment plan, the first step is confirming the presence and type of recurrent prostate cancer, as this information directly guides which treatment approaches may be appropriate.
Recurrent prostate cancer typically falls into one of three categories:
- Biochemical recurrence: Rising PSA levels after treatment, without visible disease on imaging.
- Local recurrence: Cancer returns in or near the prostate region after surgery or radiation.
- Metastatic recurrence: Cancer has spread beyond the prostate to pelvic lymph nodes, bones, or other sites.
A rising PSA level is often the earliest sign that recurrence may be present and is usually identified through routine follow-up. PSA trends, particularly PSA doubling time, can help indicate how active the disease may be, but imaging is required to determine where recurrence is located and how it should be treated.
At Vitus Private Clinic, advanced imaging is used to assess recurrence comprehensively. This includes MRI to evaluate localized disease and PSMA PET/CT with gallium-68 to detect metastatic spread throughout the body.
Together, these tools allow the extent of recurrence to be defined accurately and treatment to be planned on an individual, case-by-case basis.
Standard Salvage Treatments for Prostate Cancer Recurrence
Depending on the initial treatment, therapy options for prostate cancer recurrence may be limited. In many cases of localized recurrence, doctors rely on one of two conventional salvage approaches, selected based on the treatment used previously:
- Salvage radiation therapy: May be prescribed after a radical prostatectomy to treat the area where the prostate was removed.
- Salvage prostatectomy: May be considered for recurrence following radiation therapy, often with a higher risk of side effects, including urinary incontinence and erectile dysfunction.
In both settings, salvage treatment is commonly combined with hormone therapy (androgen deprivation therapy). Hormone therapy works by reducing levels of male hormones that support prostate cancer growth, helping to slow disease progression while salvage treatments target known tumour sites.
When prostate cancer becomes metastatic and spreads beyond the prostate, treatment using traditional approaches becomes significantly more complex. That is why metastatic prostate cancer accounts for the majority of prostate cancer–related deaths.
In these cases, doctors often prescribe a combination of hormone therapy and chemotherapy. While these treatments can help control the disease, they affect the entire body and are commonly associated with side effects such as fatigue, nausea, hair loss, neuropathy, immune suppression, and an increased risk of infection.
However, these are not the only treatment options available.
Modern Focal Therapies for Recurrent Prostate Cancer
At Vitus Private Clinic, we have helped pioneer minimally invasive focal therapies for prostate cancer that focus on precise tumour destruction while preserving surrounding structures. Because these treatments are non-thermal, they destroy cancer cells while releasing tumour-specific antigens, which help support the body’s natural immune recognition of prostate cancer.
Due to their minimally invasive nature and our extensive experience using these techniques, focal therapies can often be considered even after previous treatments such as prostatectomy or radiation, where conventional salvage options may carry higher risks to quality of life.
Irreversible Electroporation (IRE / NanoKnife)
In cases of localized recurrence, Irreversible Electroporation can be used to treat recurrent prostate cancer using a minimally invasive approach that helps preserve continence and sexual function compared to traditional salvage treatments.
Using NanoKnife technology, thin needle electrodes are placed directly into the treatment area. Electrical pulses are then delivered through the electrodes, creating pores in the cancer cell membranes and causing immediate cell death.
Each electrode is placed under continuous ultrasound guidance, allowing for custom angles and real-time adjustments during treatment. This level of control makes IRE well suited for treating complex or irregular recurrences, including cases in previously treated tissue.
Learn more about IRE for prostate cancer →
Electrochemotherapy (ECT)
Electrochemotherapy combines reversible electroporation with a chemotherapeutic agent to improve drug uptake within cancer cells while limiting effects on healthy tissue. At Vitus Private Clinic, we have helped pioneer its application to prostate cancer, where it may be used as an alternative to radiotherapy in selected cases of recurrence.
The treatment involves electrical pulses delivered to the treatment area that create pores in the cell membrane. The chemotherapeutic agent is then delivered locally, with the temporary pores improving uptake within cancer cells, which are destroyed over the following weeks.
As a result, much smaller dosages of the chemotherapeutic agent are required compared to traditional chemotherapy, and most treatments are completed in a single session. This helps avoid the common side effects associated with chemotherapy in most patients, while offering a minimally invasive option for treating prostate cancer recurrences.
Learn more about electrochemotherapy for prostate cancer →
IRE with Electrochemotherapy (IRECT)
IRECT is a minimally invasive prostate cancer treatment that is only available at Vitus Private Clinic. It combines Irreversible Electroporation and Electrochemotherapy in a single treatment to address both the main area of recurrence and surrounding cancer cells.
IRE is used to destroy the core tumour through electrical pulses that cause immediate cell death. Electrochemotherapy is then applied in the surrounding area, where electrical pulses improve uptake of a chemotherapeutic agent and cancer cells are destroyed over time. This creates a wider treatment zone than IRE alone.
This approach is used in more complex or advanced prostate cancer cases, including recurrent disease after previous treatments. It is particularly helpful when recurrence does not form a single, well-defined tumour or when cancer extends into tissue that has already been treated.
Learn more about IRECT for prostate cancer →
Photodynamic Therapy (PDT)
In cases of smaller, localized recurrences, photodynamic therapy can be an effective option. This treatment involves applying a photosensitizer to the treatment area, where it is preferentially absorbed by cancer cells.
The photosensitizer is then exposed to a specific wavelength of light, which activates and destroys the prostate cancer cells while largely leaving surrounding tissue intact.
At Vitus Private Clinic, photodynamic therapy is used more selectively than other focal treatments, but it is actively evaluated alongside IRE, IRECT, and electrochemotherapy when determining the most appropriate focal treatment approach.
Immunotherapy for Metastatic Prostate Cancer Recurrence
One of the key benefits of our minimally invasive focal therapies is their potential to create an abscopal effect. These treatments use non-thermal ablation techniques, which destroy the tumour while releasing prostate-specific antigens into the body.
Prostate cancer is typically considered a “cold” tumour, meaning it does not respond well to immunotherapy on its own. By releasing tumour antigens during focal treatment, therapies such as IRE, ECT, and PDT help stimulate an immune response that can extend beyond the primary treatment area.
This immune response can then be further supported through immunotherapy. At Vitus Private Clinic, immunotherapy is used in combination with focal ablation to strengthen the body’s ability to recognize and kill cancer cells throughout the body.
This combined approach offers a way to address metastatic prostate cancer recurrence while preserving quality of life and avoiding many of the side effects associated with traditional systemic treatments.
How Treatment Is Selected
There is no standard pathway for treating recurrent prostate cancer. While each of our focal therapies offers a gentler alternative to traditional salvage treatments, the exact operations or combination therapies vary to treat each specific case of prostate cancer.
Some of the key factors our doctors look for when creating a treatment plan include:
- Size and shape of the recurrence: Many recurrences are irregularly shaped or located close to critical structures. Our ultrasound-guided focal therapies allow precise treatment of complex lesions that are difficult to address with conventional salvage options.
- Extent of recurrence: Small, localized recurrences may be treated focally, while more extensive disease may require combined approaches such as IRECT. When cancer has spread beyond the prostate, immunotherapy can be used to support systemic disease control.
- Location relative to previously treated tissue: Recurrence often develops in tissue affected by prior surgery or radiation. Non-thermal focal therapies allow treatment in these areas while minimizing additional damage to surrounding structures.
- Findings on MRI and PSMA PET imaging: Advanced imaging is used to determine where recurrence is located and how it behaves, helping guide whether a single focal treatment or a broader strategy is most appropriate.
- Risk to urinary continence and sexual function: Preserving function is a core consideration, particularly after prior treatment, where traditional salvage therapies carry higher risks.
When Treatment Should Begin
Recurrent prostate cancer treatment does not always need to begin immediately. In many cases, the most important first step is taking the time to carefully evaluate how and where the cancer has returned, so that treatment can be planned with precision.
At Vitus Private Clinic, timing is guided by when recurrence can be clearly identified and treated accurately, rather than by PSA values alone. Because our team has long-standing experience developing and using focal therapies for prostate cancer, we are able to assess candidacy in more complex cases than clinics with more limited experience.
To determine which of our treatments is appropriate, our team reviews your MRI and biopsy results and uses this information to plan a personalized approach.
What to Expect After Treatment for Recurrence
After focal treatment for recurrent prostate cancer, recovery and follow-up focus on preserving quality of life while monitoring treatment response over time. In experienced focal therapy centers, post-treatment care is typically tailored to the individual rather than delivered through rigid protocols.
Prostate cancer patients can generally expect:
- Short recovery time: Minimally invasive focal treatments often allow a faster return to normal activities, with fewer long-term side effects than traditional salvage therapies.
- Continence and sexual function: With non-thermal focal therapies, urinary continence has been maintained, while erectile dysfunction rates have typically remained within 0–10%, depending on disease location and prior treatment.
- Post-treatment monitoring: PSA levels are monitored over time, with greater emphasis on PSA trends and correlation with imaging rather than absolute PSA thresholds alone.
- Follow-up imaging when appropriate: MRI or PSMA PET imaging may be used selectively to assess treatment response or clarify findings, rather than on a fixed schedule.
- Long-term follow-up: Ongoing monitoring remains important after recurrence to track both disease status and functional outcomes, with additional focal treatment considered in selected cases if needed.
Expert Case Review for Recurrent Prostate Cancer
Because recurrent prostate cancer can present in many different ways, determining whether additional treatment is appropriate requires careful review of prior therapies, imaging findings, and overall disease characteristics.
For men seeking clarity on their options, a second-opinion review can help assess whether focal or combined approaches may be considered based on individual findings.
Contact the team at Vitus Private Clinic to request a case review and discuss which treatment options may be appropriate.
Frequently Asked Questions
Yes, in some cases. Prior surgery or radiation does not automatically exclude focal therapy, but it does change how recurrence is evaluated and treated. At Vitus Private Clinic, advanced imaging and careful review of prior treatment effects are used to determine whether focal or combined approaches may be appropriate.
Not necessarily. A rising PSA can be an early signal of recurrence, but treatment decisions are guided by where recurrence is located and how it behaves on imaging, not PSA alone. In many cases, careful evaluation and planning come before any intervention.
Treatment selection is based on factors such as the size, shape, and extent of recurrence, as well as its location relative to previously treated tissue. In some cases, a single focal approach is sufficient, while more complex patterns of recurrence may benefit from combined treatments.
Focal therapy may still play a role in selected cases, particularly when combined with other treatments. While focal therapies target known areas of disease, immunotherapy may be used alongside them to support the body’s immune response in cases of metastatic recurrence.
Evaluation typically includes review of prior treatments, PSA history, MRI findings, and biopsy results when available. This information helps determine whether focal or combined treatment options may be considered and allows care to be planned on an individual basis.