A large international study suggests salvage focal therapy (sFT) provides comparable long-term cancer control to salvage radical prostatectomy (sRP) for localized radiorecurrent prostate cancer, while significantly reducing complications.
Investigators compared outcomes for men with biopsy-confirmed localized prostate cancer recurrence after prior radiotherapy. Patients treated with sFT (using high-intensity focused ultrasound or cryotherapy) were compared to those treated with sRP (primarily open surgery) from a retrospective registry.
After matching for key clinical variables, 923 eligible patients were analyzed (419 sFT; 504 sRP).
At 10 years, cancer-specific survival was 92% with sFT and 99% with sRP, a difference not statistically significant. Overall survival also showed no meaningful difference between the groups.
Perioperative morbidity differed markedly. sRP patients had a 24-fold higher adjusted odds of any complication and a nine-fold higher odds of a major complication compared to sFT recipients.
While radical prostatectomy has been the traditional standard, salvage focal therapy, which targets only the recurrence area, offers a more favorable therapeutic ratio by balancing oncological control with reduced toxicity. This observational study, representing the largest matched comparison to date, supports sFT as a viable alternative for selected men prioritizing reduced perioperative risk.