A LARGE international cohort study suggests that salvage focal therapy (sFT) offers comparable long-term cancer control to salvage radical prostatectomy (sRP) for men with localised radiorecurrent prostate cancer, while substantially reducing perioperative complications.
In the study, investigators compared outcomes in men with biopsy-confirmed, localised prostate cancer recurrence following prior radiotherapy. Patients treated with sFT were drawn from prospective UK registries evaluating high-intensity focused ultrasound (HIFU) and cryotherapy, as well as a UK focal salvage cohort. Those treated with sRP were identified from an international retrospective registry spanning 12 centres across eight countries.
After matching for key clinical variables, including recurrence risk group, PSA, tumour grade, T stage, and prior androgen-deprivation therapy, 923 eligible patients were analysed (419 sFT; 504 sRP). Among sFT patients, 77.6% underwent HIFU and the remainder cryotherapy; most sRP procedures were open surgery (74.6%), with the rest robot-assisted.
Radiorecurrent Prostate Cancer: Comparable 10-Year Survival Outcomes
At 10 years, cancer-specific survival was 92% (95% CI, 86–98%) with sFT and 99% (95% CI, 97–100%) with sRP, a difference that was not statistically significant. Overall survival at 10 years was also similar between groups, with no meaningful difference detected.
Fewer Complications with Focal Therapy
In contrast, perioperative morbidity differed markedly. Patients undergoing sRP had approximately 24-fold higher adjusted odds of experiencing any complication and more than nine-fold higher odds of a major complication (Clavien-Dindo grade 3–5) compared with those receiving sFT. Both associations were highly statistically significant (P<0.001).
Implications for Clinical Decision-Making
The authors note that while salvage radical prostatectomy has traditionally been regarded as the gold standard for localised recurrence after radiotherapy, it is technically challenging and associated with considerable morbidity. Salvage focal therapy, which targets only the area of recurrence within the prostate, may offer a more favourable therapeutic ratio by balancing oncological control with reduced toxicity.
Although the study was observational and combined prospective and retrospective datasets, it represents the largest matched comparison to date with follow-up extending to 10 years. The findings support sFT as a viable alternative to sRP for selected men with localised radiorecurrent prostate cancer, particularly those prioritising reduced perioperative risk.
Reference
Light A et al. Salvage focal therapy vs radical prostatectomy for localized radiorecurrent prostate cancer. JAMA Oncol. 2026;doi: 10.1001/jamaoncol.2025.6448.
