The following is a summary of “Salvage local treatment for recurrent prostate cancer after focal therapy: A systematic review and meta-analysis,” published in the September 2024 issue of Urology by Takemura et al.

This study aims to evaluate the effectiveness of salvage local treatments for managing recurrent prostate cancer (PCa) following initial focal therapy (FT), focusing on oncological and functional outcomes. Researchers conducted a systematic review and meta-analysis adhering to the PRISMA guidelines, incorporating data from PubMed/MEDLINE and EMBASE databases up to July 2023. The review included patients with clinically localized PCa who initially received FT and subsequently experienced relapse during surveillance, followed by salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT), or salvage focal therapy (sFT). 

The primary endpoint assessed was the biochemical recurrence rate after salvage treatment, while secondary endpoints included functional outcomes such as urinary incontinence and erectile dysfunction rates. The analysis encompassed 26 retrospective studies with a total of 990 patients. The pooled biochemical recurrence rate post-salvage treatment was 26%. Specifically, biochemical recurrence rates were 20% for sRP, 22% for sEBRT, and 42% for sFT. Functional outcomes revealed an overall pooled urinary incontinence rate of 20%, with salvage FT demonstrating the lowest prevalence, followed by sRP and sEBRT. Erectile dysfunction was observed at an overall rate of 43%, with sRP showing the highest prevalence, followed by sFT and sEBRT. 

Investigators observed substantial heterogeneity among studies, largely attributed to varying sample sizes. Meta-regression analysis indicated minimal contributions of salvage treatment modality, the extent of ablation, patient age, pre-salvage prostatic specific antigen levels, the proportion of patients with a Gleason score ≥7 at recurrence, and time elapsed between primary and salvage therapies to the observed heterogeneity. In conclusion, salvage local treatments for recurrent PCa after FT are viable options, offering acceptable oncological and functional outcomes. Among the modalities evaluated, sRP and sEBRT had the lowest biochemical recurrence rates, whereas sFT demonstrated superior functional outcomes.

Source: sciencedirect.com/science/article/abs/pii/S1078143924006306