A large international study offers encouraging news for men facing a recurrence of prostate cancer after radiation therapy. Researchers have found that salvage focal therapy (sFT) – which targets only the recurrent tumor – provides cancer control comparable to that of salvage radical prostatectomy (sRP), the traditional surgery to remove the entire prostate, but with significantly fewer complications.
The findings, published in , suggest a potential shift in treatment approaches for localized radiorecurrent prostate cancer, offering men a less invasive option with a potentially better quality of life. Historically, salvage radical prostatectomy has been considered the gold standard, but it’s a technically demanding procedure associated with a substantial risk of side effects.
Understanding Radiorecurrent Prostate Cancer and Treatment Options
Prostate cancer is a common malignancy in men. Many are successfully treated with radiation therapy. However, in some cases, the cancer can recur, even after seemingly effective treatment. When this happens, and the recurrence is localized – meaning confined to the prostate – options like sFT and sRP become considerations. SFT utilizes techniques like high-intensity focused ultrasound (HIFU) or cryotherapy to precisely target and destroy the recurrent tumor while sparing healthy prostate tissue. SRP, involves the complete removal of the prostate gland.
The Study Design and Findings
The international, multicenter cohort study analyzed data from over 900 patients with biopsy-confirmed, localized prostate cancer recurrence following prior radiotherapy (either external beam radiotherapy, brachytherapy, or both). Researchers meticulously matched 419 patients who underwent sFT with 504 who underwent sRP, ensuring comparable characteristics including recurrence risk group, PSA levels, tumor grade, T stage, and prior androgen-deprivation therapy. Data was analyzed from to .
The study revealed that at 10 years, cancer-specific survival was 92% with sFT and 99% with sRP. This difference was not statistically significant, indicating that both treatments were effective in controlling the cancer. Overall survival at 10 years was also similar between the two groups.
A Significant Reduction in Complications
Where the two treatments diverged dramatically was in the realm of complications. Patients undergoing sRP experienced approximately a 24-fold higher risk of any complication and more than a nine-fold higher risk of a major complication (defined as Clavien-Dindo grade 3-5) compared to those receiving sFT. These associations were highly statistically significant (P<0.001). Which means the difference observed is unlikely due to chance.
Within the sFT group, the majority (77.6%) underwent HIFU, while the remainder received cryotherapy. Most sRP procedures were performed using open surgery (74.6%), with the remainder utilizing a robotic-assisted approach.
Implications for Clinical Practice
The authors emphasize that while salvage radical prostatectomy has long been considered the standard of care, its technical challenges and potential for significant morbidity are considerable. Salvage focal therapy, by targeting only the affected area, may offer a more favorable balance between effective cancer control and reduced side effects.
“This study supports sFT as a viable alternative to sRP for selected men with localized radiorecurrent prostate cancer,” the researchers noted. “Particularly, it may be a good option for those prioritizing reduced perioperative risk.”
Study Limitations and Future Directions
It’s important to note that this was an observational study, combining both prospective and retrospective data. While the large sample size and 10-year follow-up period strengthen the findings, observational studies cannot definitively prove cause-and-effect relationships. Further research, including randomized controlled trials, would be valuable to confirm these results and refine patient selection criteria for sFT.
The study also highlights the importance of individualized treatment decisions. The best approach for a man with radiorecurrent prostate cancer will depend on a variety of factors, including his overall health, the extent and location of the recurrence, and his personal preferences. A thorough discussion with a qualified urologist is crucial to determine the most appropriate course of action.
Reference
Light A et al. Salvage focal therapy vs radical prostatectomy for localized radiorecurrent prostate cancer. JAMA Oncol. ;doi: 10.1001/jamaoncol.2025.6448.
