Cancer Progression After Radiation

For patients with a PSA biochemical progression after being treated with radiation.

 

Treatment Options

No Distant Metastases

  • Life expectancy more than 5 years; biopsy negative
    • Consider re-biopsy and
      • Monitoring or
      • ADT based on PSA or
      • Local therapy
        • Cryotherapy, or
        • High-intensity focused ultrasound (HIFU), or
        • Brachytherapy
  • Life expectancy more than 5 years; pelvic recurrence biopsy positive
    • Consider re-biopsy  and
      • Monitoring or
      • ADT +/- abiraterone or
      • Local therapy
        • Cryotherapy, or
        • High-intensity focused ultrasound (HIFU), or
        • Brachytherapy
    • Life expectancy more than 5 years; positive for distant metastases
      • High-volume (the presence of visceral metastasis or ≥4 bone lesions with ≥1 beyond the vertebral bodies and pelvis).
      • ADT with docetaxel and one of the following:
      • Preferred regimens:
        • Abiraterone (category 1)
        • Darolutamide (category 1)
      • Other recommended regimens:
        • Apalutamide (category 2B)
        • Enzalutamide (category 2B) or
      • ADT with one of the following:
      • Preferred regimens:
        • Abiraterone (category 1)
        • Apalutamide (category 1)
        • Enzalutamide (category 1)
      • Other Recommended Regimens:
        • Darolutamide
      • Low-volume
      • Life expectancy more than 5 years; biopsy negative
        • Consider re-biopsy and
          • Monitoring or
          • ADT based on PSA or
          • Local therapy
          • Cryotherapy, or
          • High-intensity focused ultrasound (HIFU), or
          • Brachytherapy
      • Life expectancy more than 5 years; pelvic recurrence biopsy positive
        • Consider re-biopsy and
          • Monitoring or
          • ADT +/- abiraterone or
          • Local therapy
          • Cryotherapy, or
          • High-intensity focused ultrasound (HIFU), or
          • Brachytherapy
      • Life expectancy more than 5 years; positive for distant metastases
        • Low-volume
        • ADT with one of the following:
          • Preferred regimens:
            • Abiraterone (category 1)
            • Apalutamide (category 1)
            • Enzalutamide (category 1)
          • Other Recommended regimens:
            • Darolutamide (category 2B) or
          • ADT with docetaxel and one of the following:
            • Abiraterone (category 2B)
            • Apalutamide (category 2B)
            • Darolutamide (category 2B)
            • Enzalutamide (category 2B) or
        • ADT with EBRTs to the primary tumor alone or with one of the following:
          • Abiraterone
          • Apalutamide (category 2B)
          • Docetaxel (category 2B)
          • Enzalutamide (category 2B)

Life expectancy 5 years or less

  • Observation: History and physical exam every 12 months or as needed

CLINICAL TRIALS:
NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Version 4.2023
© National Comprehensive Cancer Network, Inc. 2022. All rights reserved. The complete and current version of the guideline is available at NCCN.org.

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IMPORTANT:

This information is provided for educational purposes only to support patients in understanding and discussing appropriate treatment options with their doctors. Included is information from treatment guidelines for doctors and other sources. However, this information should not be considered as patient treatment guidelines or recommendations, but as educational materials only. Patients should discuss treatments identified herein with their doctors to understand the risks and benefits of each based on their personal diagnosis. Treatment decisions should only be made between the patient and his doctor.

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