Great question and like most things with PCa, the answer is complicated.

As I understand it, if RT was used in primary therapy, further RT may be a viable option to radiate areas that were not previously treated with radiation. Let’s take a scenario where Brachytherapy used as primary treatment. Let’s say that prostate cancer returns outside of the prostate in the lymph node basin. The lymph node basin might be able to be radiated potentially as a cure or disease management. Let’s take that idea a step further and say that there also is distant metastasis, perhaps in bones. RT might be an option there as well. In that scenario, without a doubt, your RO would be correct.

Let’s take another scenario where brachytherapy is used as the primary treatment. The radiation field includes the prostate bed. The cancer returns within the prostate and also local lymph. That was my situation. Salvage radiation was considered for the prostate along with two years of first and second generation ADT. In my case, the location of the lesions were adjacent the urethra such that a portion of the urethra would be within the radiation field for any hope of a cure and the risk of a resulting stricture from re-radiation was unacceptably high. Additionally, it was determined that the risk of permanent urinary and fecal incontinance was unacceptably high if the prostate bed was re-radiated. These risks were not discussed with me when I got my first opinion but they were discussed when I got my second opinion. I had salvage RP and will get salvage RT to the lymph node basin soon and have started two years of first and second generation ADT.

In my mind, the question is whether your RO was talking about additional radiation to areas that were not previously treated under primary therapy, or if he/she was talking about re-radiation of tissue previously treated in primary therapy which, depending on circumstances may or may not result in one or more morbidities.

Re-radiation is not the standard of care, as I understand it. You may find the following published medical paper interesting: https://ascopubs.org/doi/10.1200/JCO.23.01391

Best wishes for success on your journey with PCa.