Salvage Therapy for Prostate Cancer - Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy

Publication Date: February 14, 2024
Last Updated: February 29, 2024

Summary of Recommendations

Clinicians should offer androgen deprivation therapy (ADT) in addition to salvage RT for patients with BCR following RP and any high-risk features (e.g., higher post-prostatectomy PSA such as PSA ≥0.7ng/mL, Gleason Grade Group 4 to 5, PSADT ≤6months, persistently detectable post-operative PSA, seminal vesicle involvement). (Moderate, B)

For patients with BCR following RP without any high-risk features, clinicians may offer radiation alone. (Conditional, C)

Clinicians should discuss treatment side effects and the impact of medical comorbidities when patients are being considered for ADT (as well as duration) with salvage RT, utilizing an SDM approach. (Clinical Principle, )

For patients with pN1 disease being treated with post-operative RT, clinicians should include ADT rather than treating with RT alone. (Clinical Principle, )

When providing ADT to patients undergoing salvage RT, clinicians should provide a minimum of four to six months of hormonal therapy. (Clinical Principle, )

For patients with high-risk features, clinicians may extend ADT to 18 to 24 months. (Expert Opinion, )

In patients with BCR following RP undergoing salvage RT with ADT, clinicians may use expanded radiation fields that include the regional lymph nodes. (Conditional, B)

Clinicians should discuss with patients that including treatment of regional lymph nodes with salvage RT may increase the risk of side effects, particularly in the short term, compared to prostate bed RT alone. (Moderate, A)

Clinicians should not recommend the addition of docetaxel in patients undergoing salvage RT and ADT. (Strong, B)

For pN0 patients, clinicians should recommend the use of intensified androgen receptor (AR) suppression with salvage RT only within a clinical trial setting. (Clinical Principle, )

Recommendation Grading


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Salvage Therapy for Prostate Cancer - Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy

Authoring Organizations

Publication Month/Year

February 14, 2024

Last Updated Month/Year

March 13, 2024

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part II of a 3-part series focusing on treatment delivery for non-metastatic biochemical recurrence (BCR) after primary radical prostatectomy (RP). Please refer to Part I for discussion of treatment decision-making and Part III for discussion of evaluation and management of recurrence after radiotherapy (RT) and focal therapy, regional recurrence, and oligometastasis.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant




prostate cancer, Biochemical Recurrence, BCR, non-metastatic prostate cancer

Source Citation

Morgan, Todd M.*; Boorjian, Stephen A.; Buyyounouski, Mark K.; Chapin, Brian F.; Chen, David Y. T.; Cheng, Heather H.; Chou, Roger; Jacene, Heather A.; Kamran, Sophia C.; Kim, Sennett K.; Kirkby, Erin; Luckenbaugh, Amy N.; Nathanson, Ben J.; Nyame, Yaw A.; Posadas, Edwin M.; Tran, Phuoc T.; Chen, Ronald C. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy, Journal of Urology:  - Volume 0 - Issue 0 doi: 10.1097/JU.0000000000003891

Supplemental Methodology Resources

Data Supplement


Number of Source Documents
Literature Search Start Date
July 1, 2022
Literature Search End Date
July 26, 2023