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Radical prostatectomy may be considered in the small subset of men who initially had cancer confined to the prostate, if the local recurrence of cancer appears to be well- to moderately well-differentiated (a Gleason score of 7 or lower) and still confined within the prostate, and if the PSA level is less than 10. But even in these, the best possible candidates for prostate surgery after radiation treatment, the complications are much higher than for men who have surgery first. The risk of incontinence is as high as 25 percent, and other injuries—to delicate rectal tissue made even more fragile by radiation, for example—also are much more common.

Recently cryotherapy—freezing the prostate—has been considered as a “Plan B” for radiation with a rising PSA. But at the writing of this book, there is only preliminary information available on how often this affects the tumor, and on the complications that might accompany cryotherapy after the prostate has been irradiated.

The bottom line, for most patients who have a progressive increase in PSA after radiation therapy, is that it’s unlikely that any form of additional treatment will cure the cancer. One option is that these patients begin hormone therapy in an attempt to shrink the tumor (for a discussion of hormone therapy. Another is that they be followed closely with watchful waiting, and that they receive additional treatment only if or when they have symptoms of metastatic disease.

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