Salvage treatment for radio-recurrent prostate cancer: a review of literature with focus on recent advancements in image-guided focal salvage therapies.

Biochemical recurrence of prostate cancer occurs in 25-33% of patients who undergo radiation therapy (RT). Unfortunately, greater than 90% of patients with radiation recurrence undergo androgen deprivation therapy (ADT), despite the detrimental side effect profile and the lack of supporting evidence for ADT use in local recurrence. In patients who experience recurrence after treatment with RT, options for treatment include salvage radical prostatectomy (SRP), salvage cryotherapy (SCT), salvage brachytherapy (SBT), and high-intensity focused ultrasound (HIFU). These salvage treatments provide recurrence-free survival in almost half of the patients with an acceptable safety profile. However, it is important to note that approximately 20-40% of radio-recurrent prostate cancers are isolated and local. Recent studies have shown salvage focal treatments to have encouraging outcomes with significantly less side effects. This article summarizes the outcomes of currently used salvage treatment options for radio-recurrent prostate cancer and focuses on recent advancements in image-guided focal salvage therapies.