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Overview
Source: Prostate Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 14, 2025 · Captured 2026-09-09.
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Context: Treatment of Recurrent Hormone-Sensitive or Hormone-Resistant Prostate Cancer
In recurrent hormone-sensitive or hormone-resistant prostate cancer, the selection of further treatment depends on many factors, including:
Previous treatment.
Site of recurrence.
Coexistent illnesses.
Individual patient considerations.
Definitive radiation therapy can be given to patients with disease that fails only locally after prostatectomy.[1-4] A randomized trial (RTOG-9601 [NCT00002874]) has shown improved overall survival (OS) and prostate–cancer-specific survival with the addition of high-dose bicalutamide to radiation therapy compared with radiation therapy alone in men with locally recurrent prostate cancer after radical prostatectomy.[5]
In the trial, 760 men who were initially treated with radical prostatectomy for tumor stage T2 or T3, and who had a detectable prostate-specific antigen (PSA) level of 0.2 to 4.0 ng/mL, but no evidence of metastases, were randomly assigned to receive radiation (64.8 Gy over 36 fractions) and either bicalutamide (150 mg PO qd) or placebo for 24 months. The median interval from surgery to PSA detectability was 1.4 years and from surgery to randomization was 2.1 years. Median follow-up was 13 years.
Actuarial OS at 12 years was 76.3% in the bicalutamide group versus 71.3% in the placebo group (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.59–0.99; P = .04).[5][Level of evidence A1]
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Prostate–cancer-specific mortality at 12 years was 5.8% (bicalutamide) versus 13.4% (placebo), (HR, 0.49; 95% CI, 0.32–0.74; P < .001).[5][Level of evidence A1]
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Most treatment-related toxicities were similar between the two groups, except for gynecomastia, which occurred in 69.7% of the men who received bicalutamide versus 10.9% of those who received placebo. This side effect may be mitigated by prophylactic breast irradiation, which was not used in this study because of the double-blinded design.
Some patients with a local recurrence after definitive radiation therapy can undergo salvage prostatectomy.[6] However, only about 10% of patients treated initially with radiation therapy will have local relapse only. In these patients, prolonged disease control is often possible with hormonal therapy, with median cancer-specific survival of 6 years after local failure.[7]
Cryosurgical ablation of recurrence after radiation therapy is frequently associated with a high complication rate. This technique is still undergoing clinical evaluation.[8]
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Hormonal therapy is used to manage most relapsing patients with disseminated disease who initially received locoregional therapy with surgery or radiation therapy. For more information, see the Treatment Options for Stage IV Prostate Cancer section.
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Studies cited in this source section
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Preserved source evidence · Not medical advice