Ten‑Year Outcomes and Selection Issues for Salvage Focal Therapy After Radiorecurrence

A recent study describes long-term follow-up comparing salvage focal ablative therapy with salvage radical prostatectomy in men with biopsy-confirmed, localized recurrence after prior radiotherapy. The headline efficacy comparison was 10-year cancer-specific survival of 92% with focal therapy and 99% with prostatectomy, which the report characterized as similarly high across approaches. The report frames the comparison across oncologic outcomes and perioperative burden, highlighting differences in complications and ongoing questions about patient selection.

The underlying analysis drew from an international cohort assembled across centers from 2000 to 2024 and included 923 patients with biopsy-confirmed, localized recurrent prostate cancer after radiotherapy (external beam radiotherapy, brachytherapy, or both). The report describes a comparison of focal salvage ablative therapies versus surgery, using a matched-cohort approach to align groups on clinical and disease features. Within the focal-therapy arm, high-intensity focused ultrasound accounted for most cases, with cryotherapy comprising the remainder. In this framing, the dataset is presented as a long-horizon, cross-center comparison that pairs cancer-control estimates with procedural outcomes over extended follow-up.

Perioperative morbidity was a key point of separation between focal approaches and salvage radical prostatectomy. In the unmatched cohort figures cited, perioperative complications were reported in 5.7% of focal-therapy patients versus 59.9% of surgery patients, while major complications were reported in 1.4% versus 12.5%, respectively. The summary also reports matched-cohort odds ratios indicating higher odds of any complication (OR, 24.20) and major complications (OR, 9.31) with prostatectomy. Taken together in the report, the pattern is described as fewer complications being reported with focal therapy, with complication burden positioned as a central differentiator between the approaches.

Focal therapy is described as a less morbid alternative that may be comparably effective for some patients, while the summary also underscores unresolved uncertainties. The report notes limitations related to potential unmeasured confounding, including baseline urinary, bowel, or sexual function and radiation dose from initial treatment. It also relays open questions about how reirradiation might fit among salvage options and how pathologic mapping at recurrence should inform selection between focal and whole-gland approaches.

Selection and localization are presented largely through the recurring requirement that recurrence be biopsy-confirmed and localized, alongside questions about how biopsy-based pathologic findings at recurrence should guide treatment choice. The report did not specify imaging thresholds for proceeding with focal versus whole-gland salvage. It links decision-making to how confidently disease can be mapped and characterized at recurrence, and it treats localization and pathologic guidance as areas where consensus is still evolving rather than as a settled algorithm.

Key Takeaways:

• Medscape reports 10-year cancer-specific survival estimates of 92% after salvage focal therapy and 99% after salvage radical prostatectomy in this international cohort analysis.
• Medscape reports markedly lower perioperative and major complication rates with focal therapy than with surgery, alongside matched-cohort odds ratios indicating higher odds of complications with prostatectomy (OR 24.20 for any complication; OR 9.31 for major complications).
• Medscape highlights unresolved issues including possible unmeasured confounding (baseline urinary/bowel/sexual function and radiation dose), where reirradiation fits, how pathologic mapping at recurrence should guide selection, and the absence of patient-reported quality-of-life outcomes.