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
- Androgen Deprivation Therapy (ADT) based on PSA or
- Local therapy +/- ADT
- Cryotherapy, or
- High-intensity focused ultrasound (HIFU), or
- Brachytherapy
- Consider re-biopsy and
- Life expectancy more than 5 years; pelvic recurrence biopsy positive
- Consider re-biopsy and
- Monitoring or
- ADT +/- abiraterone or
- Local therapy (eg, radiation to the lymph nodes) +/- ADT
- Consider re-biopsy and
With Distant Metastases
Treatment selection is based on the volume of disease. Options may include:
- ADT + docetaxel + one of the following:
- Abiraterone
- Apalutamide
- Darolutamide
- Enzalutamide
- ADT + one of the following:
- Abiraterone
- Apalutamide
- Docetaxel
- Enzalutamide
Life expectancy 5 years or less
- Observation: History and physical exam every 12 months or as needed
CLINICAL TRIALS:
NCCN recognizes the importance of clinical trials and encourages participation when applicable and available. Trials should be designed to maximize inclusiveness and broad representative enrollment.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Version 2.2025
© National Comprehensive Cancer Network, Inc. 2025. All rights reserved. The complete and current version of the guideline is available at NCCN.org.
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.