Top Line: Isolated local recurrence is uncommon after radiation for prostate cancer, and review data converges on 5-15% local recurrence rates depending on risk category.
The Study: When it does happen, though, it can be challenging to manage with curative intent. The strongest data comes from salvage reirradiation where there are multiple prospective single arm trials. F-SHARP was a single arm, phase I/II trial that enrolled 62 patients with biopsy confirmed recurrent prostate cancer after prior definitive RT. Of note, those with prior grade 3+ GI or GU effects from RT and those with IPSS >20 were excluded. Prior RT included IMRT (59.7%), LDR (24.2%), proton therapy (11.3%), and SBRT (3.2%). They were treated with focal HDR brachytherapy to gross disease. Initially, the prescription was 30 Gy in 1 fraction (38.7%), but this was expanded to 30 Gy in 2 fractions (61.3%) part-way through the study. Only 8.1% received ADT. Adverse effects were limited with no acute grade 3+ GI or GU events. Two people had late grade 3 urethral stricture. At 3 years, biochemical PFS was 62.7%, radiographic PFS was 67.5%, local recurrence free survival was 73%. Importantly, the vast majority of patients (83%) were free from ADT at 3 years. There were no differences in outcomes between single fraction and 2-fraction HDR. Genomic classifiers were performed, and higher GC was associated with worse clinical outcomes suggesting the potential for improvement with treatment intensification.
TBL: In this prospective trial, salvage focal HDR brachytherapy had encouraging outcomes for patients with radiorecurrent prostate cancer and GC scores were prognostic of outcome. | Solanki, J Clin Oncol 2026
The Study: When it does happen, though, it can be challenging to manage with curative intent. The strongest data comes from salvage reirradiation where there are multiple prospective single arm trials. F-SHARP was a single arm, phase I/II trial that enrolled 62 patients with biopsy confirmed recurrent prostate cancer after prior definitive RT. Of note, those with prior grade 3+ GI or GU effects from RT and those with IPSS >20 were excluded. Prior RT included IMRT (59.7%), LDR (24.2%), proton therapy (11.3%), and SBRT (3.2%). They were treated with focal HDR brachytherapy to gross disease. Initially, the prescription was 30 Gy in 1 fraction (38.7%), but this was expanded to 30 Gy in 2 fractions (61.3%) part-way through the study. Only 8.1% received ADT. Adverse effects were limited with no acute grade 3+ GI or GU events. Two people had late grade 3 urethral stricture. At 3 years, biochemical PFS was 62.7%, radiographic PFS was 67.5%, local recurrence free survival was 73%. Importantly, the vast majority of patients (83%) were free from ADT at 3 years. There were no differences in outcomes between single fraction and 2-fraction HDR. Genomic classifiers were performed, and higher GC was associated with worse clinical outcomes suggesting the potential for improvement with treatment intensification.
TBL: In this prospective trial, salvage focal HDR brachytherapy had encouraging outcomes for patients with radiorecurrent prostate cancer and GC scores were prognostic of outcome. | Solanki, J Clin Oncol 2026