Abstract illustration of radiation therapy targeting prostate cancer.

Prostate Cancer Treatment: Are You Getting the Right Radiation Therapy?

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"Understanding salvage and primary radiation options for localized prostate cancer."

Prostate cancer is a common diagnosis, and with it comes a flood of treatment options. Two key approaches involving radiation are salvage radiation therapy (SRT) and primary external beam radiotherapy (EBRT). Knowing the difference and when each is appropriate can significantly impact your treatment outcomes and overall well-being. This article breaks down the latest research to help you understand these options.

Salvage radiation therapy (SRT) is typically considered when prostate cancer recurs after an initial radical prostatectomy (RP), a surgery to remove the prostate gland. The goal of SRT is to target and eliminate any remaining cancer cells that may not have been removed during surgery. It's often recommended when a patient's PSA (prostate-specific antigen) level begins to rise again, indicating a potential recurrence.

Primary external beam radiotherapy (EBRT), on the other hand, is used as the main treatment for localized prostate cancer. This involves directing high-energy beams at the prostate gland from outside the body to destroy cancer cells. Sometimes, EBRT is combined with other treatments like brachytherapy (internal radiation) or androgen deprivation therapy (ADT) to improve its effectiveness.

Salvage Radiation Therapy (SRT): Targeting Recurrence After Surgery

Abstract illustration of radiation therapy targeting prostate cancer.

If you've had a radical prostatectomy and your PSA levels start to climb again, salvage radiation therapy (SRT) might be recommended. Research presented at a urology conference explored how SRT is used in these situations and what factors influence its use.

The study, which looked at over 1,000 patients who had undergone radical prostatectomy, found that only about 30% received SRT when their PSA levels indicated recurrence. Several factors seemed to play a role in whether or not SRT was used:

PSA Levels: SRT was more likely to be used when PSA levels were lower (ideally below 0.5 ng/mL, considered "early" SRT).
Cancer Characteristics: Higher risk factors like positive surgical margins (cancer cells found at the edge of the removed tissue), higher T-stage (more advanced cancer), and higher grade group (more aggressive cancer cells) were associated with increased SRT use.
Practice Variation: Interestingly, the study found significant differences in SRT utilization across different medical practices, even after accounting for patient and cancer characteristics. This suggests that factors beyond just the patient's condition influence treatment decisions.

The researchers concluded that there's a need to better understand why SRT isn't used more often, especially in patients with higher-risk features who could benefit from it. The findings highlight the importance of discussing SRT with your doctor if you experience a recurrence after prostatectomy.

Primary EBRT: When is Nodal Irradiation Necessary?

For men undergoing primary EBRT, another important question is whether or not to irradiate the pelvic lymph nodes. The National Comprehensive Cancer Network (NCCN) recommends this approach for men with high-risk prostate cancer, as it helps to target cancer cells that may have spread beyond the prostate gland. However, a study examining data from a large national cancer database revealed some interesting trends.

About this Article -

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Everything You Need To Know

What is the primary difference between Salvage Radiation Therapy (SRT) and primary External Beam Radiotherapy (EBRT) in treating prostate cancer?

The main distinction lies in their application. Salvage Radiation Therapy (SRT) is administered when prostate cancer returns after a Radical Prostatectomy (RP), a surgical procedure to remove the prostate. Its purpose is to eliminate any remaining cancer cells. Primary External Beam Radiotherapy (EBRT), on the other hand, serves as the initial treatment for localized prostate cancer. It utilizes high-energy beams directed at the prostate gland to eradicate cancer cells from the outset. Essentially, SRT addresses recurrence post-surgery, while EBRT is a standalone treatment.

Under what circumstances is Salvage Radiation Therapy (SRT) typically recommended for prostate cancer patients?

SRT is usually considered when prostate cancer recurs after a Radical Prostatectomy (RP). A rising PSA (prostate-specific antigen) level often indicates a potential recurrence, prompting the recommendation for SRT. Research suggests that early intervention, ideally when PSA levels are below 0.5 ng/mL, yields better outcomes. Additional factors, such as positive surgical margins, higher T-stage, and a higher grade group, also influence the decision to utilize SRT.

What factors influence the decision to use Salvage Radiation Therapy (SRT) after a Radical Prostatectomy?

Several factors influence the decision to use SRT. PSA levels are crucial; SRT is more likely to be employed when PSA levels are lower. Cancer characteristics also play a role; higher-risk factors like positive surgical margins, higher T-stage, and a higher grade group increase the likelihood of SRT use. Furthermore, variations in practice can affect SRT utilization, suggesting that factors beyond the patient's condition influence treatment decisions.

In the context of Primary EBRT, why is nodal irradiation an important consideration?

Nodal irradiation is important for men undergoing Primary EBRT, especially those with high-risk prostate cancer. The National Comprehensive Cancer Network (NCCN) recommends irradiating the pelvic lymph nodes in these cases to target any cancer cells that might have spread beyond the prostate gland. This approach is essential for effectively treating more advanced cancers and preventing further spread.

What are the implications of differing approaches to Salvage Radiation Therapy (SRT) utilization across medical practices?

The variation in SRT utilization across different medical practices, even after accounting for patient and cancer characteristics, suggests that factors beyond the patient's condition influence treatment decisions. This implies that access to SRT, as well as the physician's approach and treatment philosophies, can significantly impact a patient's treatment path. This highlights the importance of discussing SRT with your doctor if you experience a recurrence after a Radical Prostatectomy (RP) and seeking a second opinion if needed to ensure the most appropriate care, tailored to your individual needs and the latest research.