If there is a new increase in PSA after treatment of prostate cancer, appropriate clarifications or examinations such as MRI and PSMA PET/CT must be carried out in order to distinguish whether it is a local or distant recurrence. Over 50% of recurrences are local recurrences.
In the case of a local recurrence, a large number of treatment alternatives (surgery, conventional radiation, Cyberknife therapy, cryotherapy, focused ultrasound (HIFU), brachytherapy) are available. Systemic therapy (anti-hormonal therapy) is preferably used when patients are not eligible for an invasive procedure due to their poor general condition or when they do not consent to an invasive procedure. The risks of invasive therapy such as bleeding, urethral strictures, fistulas, incontinence and impotence must be taken into account and weighed up. The treatment indication must be analyzed very critically, especially in older or multimorbid patients.