"Salvage" is a word we use when we have a rising PSA after surgery or radiation. This does not always mean that the cancer has spread outside the initial area and sometimes "Salvage" therapy will stop its spread. Sometimes "Salvage" Therapy is included as part of Advanced Disease treatment and sometimes it is just an extension of the initial therapy.
Following is from the beginning of an article "Patient information: Advanced prostate cancer" by Nancy A Dawson and Diane MF Savarese and published by "Up to Date Information". You can read the complete article by clicking "here".
SALVAGE LOCAL THERAPY FOR A RISING PSA AFTER SURGERY OR RADIATION — As noted above, some men with a rising PSA as the only sign of disease recurrence may be curable with further local therapy. Men who have the best chance of long-term control of the prostate cancer with local-only therapy are those who have less aggressive cancers (ie, lower Gleason grade and lower PSA level), and a slowly rising PSA level.
The best treatment for this situation depends upon a number of factors.
Salvage radiation — Some men who initially had prostate surgery may be successfully treated with radiation therapy, as long as immediate postoperative EBRT was not administered. The best candidates for this approach are men who meet all of the following criteria:
A positive surgical margin, and/or Gleason score <8, and no evidence of lymph node involvement at the time of initial prostatectomy
A low PSA (optimally 1.5 ng/mL) at the time of recurrence
At least one year elapsed between the surgery and the rise in PSA
For men who had unfavorable risk factors at the time of radical prostatectomy (eg, PSA >10 ng/mL, Gleason score 8, T2b disease, show table 1), or if the post-prostatectomy PSA doubling time is 10 months, the addition of short-term androgen deprivation therapy (two months before and during salvage EBRT) may be recommended.
Men who do not meet these criteria are usually offered hormone therapy alone without radiation therapy (see "Androgen deprivation therapy" below).
Salvage prostatectomy — Selected men with a rising PSA following radiation therapy for a localized prostate cancer may be able to undergo prostatectomy (termed "salvage" prostatectomy). However, salvage prostatectomy can be associated with serious side effects, and all men are not good candidates.
Optimal candidates are men who are unlikely to have tumor spread outside the prostate, have a life expectancy of at least 10 years, and who had a Gleason score 6, a pretreatment serum PSA <10 ng/mL, and T1c or T2a tumor stage at initial diagnosis. At the time when the recurrence is found, similar conditions should also be met (ideally, with a serum PSA <4.0 ng/mL).
Men at the highest risk for having disease outside of the prostate include those with a rapid PSA doubling time (particularly less than three to six months), high Gleason score tumors, and a short interval between the original treatment and the time when the PSA begins to rise again; these men are not good candidates for salvage prostatectomy. These men may be offered cryotherapy or androgen deprivation therapy.
Cryotherapy — Cryotherapy is sometimes recommended for men who have a rising PSA after EBRT, and who meet the criteria for salvage prostatectomy, but have more advanced tumor in the region of the prostate (ie, T3 disease, show table 1) at the time of initial diagnosis or recurrence.
Androgen deprivation therapy — For men who are not suitable candidates for local therapy because they have metastases, a short PSA doubling time (3 months), significant underlying medical illness, or an unfavorable balance of risks and benefits for definitive salvage therapy, traditional androgen deprivation therapy (ADT) is usually the treatment of choice. The general aspects of ADT are discussed in detail above (see "Androgen deprivation therapy" above).
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