Salvage Therapy for Prostate Cancer and Other Malignancies

Definition and Intent

Salvage therapy represents a second-line curative approach undertaken after failure of primary definitive treatment, with the goal of achieving long-term disease control or cure in patients who have not yet developed widespread metastatic disease 1, 2, 3
The American Urological Association defines salvage therapy as treatment administered with curative or palliative intent after initial definitive therapy has failed, most commonly applied when patients experience biochemical recurrence or disease progression following primary treatment 1, 2

After radical prostatectomy, salvage radiation therapy to the prostate bed is the primary curative-intent salvage treatment for biochemical recurrence without metastatic disease, with androgen deprivation therapy added for patients with high-risk features 4, 5, 6
The European Association of Urology recommends a minimum duration of androgen deprivation therapy of 4-6 months when combined with salvage radiation therapy, with extension to 18-24 months for patients with multiple high-risk features 7
After radiation therapy or focal ablation, salvage treatment options include salvage radical prostatectomy, cryoablation, high-intensity focused ultrasound, or reirradiation, with prostate biopsy required before any local salvage therapy to confirm recurrent cancer 1, 2, 3, 8

For pelvic nodal recurrence following radical prostatectomy, salvage radiation therapy to the prostate bed and pelvic lymph nodes plus androgen deprivation therapy should be offered, with salvage treatment largely reserved for Grade Group 2 and higher recurrences in individuals with life expectancy greater than 5-10 years 1, 2

In lymphomas, high-dose chemotherapy followed by autologous stem cell transplantation serves as salvage therapy after failure of primary chemotherapy regimens, although this is not directly cited in the provided text, it is a general principle in oncology
In germ cell tumors, salvage chemotherapy is used for relapse after primary treatment, with surgery playing a role in localized or late relapses, as recommended by the European Society for Medical Oncology 9
In testicular seminoma, chemotherapy is the salvage treatment of choice after radiation failure, though re-irradiation may be considered for localized, small-volume relapse with long intervals, as per the National Comprehensive Cancer Network guidelines 9