If your PSA level begins to rise following a radical prostatectomy, then this is clear evidence that the cancer is coming back. However, it is often 5 years or more before any actual symptoms would appear.

For those men whose recurrence of the prostate cancer is confined to the original site of the prostate gland (the prostate bed), with no spread to other parts of the body, then further treatment with radiotherapy to the affected area might be considered.

Because the previous surgery will have changed the anatomy of the prostate area and because the PSA usually begins to rise when the cancer is still very small, scans and x-rays are not very helpful in deciding whether or not the tumour has spread. The things which help in making this decision relate to both the findings when the original cancer was removed and the current PSA.
The factors relating to the original cancer which suggest the recurrence may be localised to the prostate bed are:

• a Gleason score of less than 8
• no evidence of tumour spread to the lymph nodes in the pelvis
• no evidence of tumour spread to the seminal vesicles (these are the small tubes immediately above and behind the prostate gland, which store the sperm)

The factors relating to the current PSA which suggest the recurrence may be localised to the prostate bed are:

• the PSA level has begun to rise more than a year after surgery
• the PSA level is only rising slowly
• the PSA level is still below 2

If the evidence suggests that the recurrence is still confined to the prostate bed then a course of radiotherapy might be suggested. This would involve external beam treatment, using a machine called a Linear Accelerator.

'Salvage' radiotherapy controls the rising PSA in about 40% of men. The radiotherapy does not usually cause any sever long-term side effects, apart from a small risk of bowel disturbance.

Active monitoring simply involves watching the PSA and having regular check-ups to make sure no symptoms have developed. When problems do finally appear then treatment with hormone therapies will be started. At the moment there is no clear evidence that starting these same hormonal treatments as soon as the rising PSA is confirmed actually increases life expectancy. So the choice of 'treatment' option is usually decided by discussions between individual patients and their specialists.