Proactive Patient Communication: Early Discussion on Salvage Therapies for Prostate Cancer

Currently, there's no level one evidence establishing a precise timeline for initiating salvage therapies in patients with prostate cancer, according to Sophia Kamran, MD, Harvard Medical School and Mass General Cancer Center. However, substantial lower-level data suggests that earlier initiation of salvage therapy is associated with improved long-term oncologic outcomes. In an interview with Targeted Oncology^TM at the 2025 AUA Annual Meeting, Kamran discusses updated guidelines for these patients.

Kamran recommends referring patients to radiation oncology as soon as they meet the criteria for biochemical recurrence. It can be beneficial to begin discussing salvage therapy options with patients early, even postoperatively when PSA is undetectable, especially if they have significant risk factors for recurrence. Counseling them upfront about the potential need for future therapies is also crucial.

Regarding the sequencing of salvage therapies, for Kamran, it depends on the planned treatment. For salvage radiation therapy combined with hormone therapy, oncologists could initiate hormone therapy first, particularly if the patient is still recovering from prostatectomy side effects like incontinence. However, this isn't mandatory, and Kamran believes that as long as hormone therapy is concurrent with salvage radiation, the timing is appropriate.