How do you approach salvage of a local-only recrurrence of prostate cancer after definitive external beam radiation?

We continue to prefer "zero margin" whole gland "HDR-like" SBRT for this circumstance for prior external beam RT cases, *34 Gy/5 fx, though would exclude any patient that has preexisting grade 2 or higher toxicity from their original RT course (otherwise, no specific exclusions, if the metastatic w/u is NED). For post-brachytherapy relapse, we would consider a more "focal" salvage SBRT regimen, particularly if a PET/CT and/or MRI overlay versus the prior brachytherapy dosimetry map indicates rec...

This is not an uncommon situation. The first thing to do is to assess the patient. If the PSA is rising slowly and life expectancy is short, observation without any intervention may be the best approach. If this is not the situation, then assure there is no evidence of regional or distant metastasis. Typically, I recommend a fluciclovine PET-CT. If you have access to better PET imaging (PSMA), that is preferred. Frequently, insurance companies will demand more conventional imaging first (CT A/P,...