The American Urological Association (AUA), in partnership with the American Society for Radiation Oncology (ASTRO) and the Society of Urologic Oncology (SUO), has released the 2024 clinical practice guideline on salvage therapy for prostate cancer. This guideline aims to address the critical area of prostate cancer care, focusing on the evaluation and appropriate use of salvage therapies for patients with biochemical recurrence.

According to the guideline, while the definitive standard-of-care therapies cure most patients with clinically localized prostate cancer, the risk of recurrence and subsequent metastasis is over 50% in patients with the highest disease risk features. The guideline emphasizes the importance of balancing undertreatment with overtreatment, utilizing new therapeutic agents and imaging modalities, and optimizing patient selection with evidence-driven prognostic markers to improve oncologic outcomes and maintain the quality of life for these patients.

The guideline, chaired by Todd Morgan, MD, consists of 30 recommendations and serves as a valuable reference for effective evidence-based care related to salvage therapy for prostate cancer. One of the key points highlighted in the guideline is the potential benefits of radiation as a salvage therapy after radical prostatectomy, which has been shown in clinical trials to improve survival outcomes, delay cancer progression, and offer a second chance at cure for many patients.

Ronald C. Chen, MD, MPH, FASTRO, Vice Chair of the Guideline Panel and Professor and Chair of Radiation Oncology at the University of Kansas Medical Center in Kansas City, emphasized the importance of the guideline in providing a framework for multidisciplinary teams to personalize treatments based on best practices developed through decades of research.

The guideline includes a focus on various topics such as treatment decision-making at the time of suspected biochemical recurrence after primary radical prostatectomy, treatment delivery for non-metastatic biochemical recurrence after primary radical prostatectomy, evaluation and management of suspected non-metastatic recurrence after radiation therapy, and management of regional recurrence.