Top Line: For biopsy-proven, prostate-confined radiorecurrence, can salvage focal therapy (sFT) go toe-to-toe with salvage radical prostatectomy (sRP)?
The Study: This international matched cohort study of 923 men with localized, radiorecurrent prostate cancer matched 419 patients from prospective cohorts of sFT with 504 who underwent sRP. In the sFT group, most were treated with high intensity focused ultrasound (HIFU, 77.6%) while the rest had cryotherapy. In most sFT patients (57.5%), the involved quadrant was treated with focal therapy. At 10 years, there was no significant difference in cancer specific survival (92% sFT v 99% sRP). Overall survival was 90% (sFT) v 83% (sRP) at 5 years and 57% v 72% at 10 years. As we can see, survival curves crossed over time and may have, in some part, been related to significant differences in baseline patient characteristics such as age. Survival favored sFT before 5 years and sRP after. Toxicity, however, was no photo finish. Perioperative complications were higher after sRP (59.9% v 5.7%). The risks of any complication (OR 24.2) and major complication (OR 9.3) were also significantly higher after sRP.
TBL: For properly selected men with localized radiorecurrence, sFT appears oncologically comparable to sRP at 10 years—with fewer perioperative complications. In an older, comorbid population, that therapeutic ratio is hard to ignore. | Light, JAMA Oncol 2026
The Study: This international matched cohort study of 923 men with localized, radiorecurrent prostate cancer matched 419 patients from prospective cohorts of sFT with 504 who underwent sRP. In the sFT group, most were treated with high intensity focused ultrasound (HIFU, 77.6%) while the rest had cryotherapy. In most sFT patients (57.5%), the involved quadrant was treated with focal therapy. At 10 years, there was no significant difference in cancer specific survival (92% sFT v 99% sRP). Overall survival was 90% (sFT) v 83% (sRP) at 5 years and 57% v 72% at 10 years. As we can see, survival curves crossed over time and may have, in some part, been related to significant differences in baseline patient characteristics such as age. Survival favored sFT before 5 years and sRP after. Toxicity, however, was no photo finish. Perioperative complications were higher after sRP (59.9% v 5.7%). The risks of any complication (OR 24.2) and major complication (OR 9.3) were also significantly higher after sRP.
TBL: For properly selected men with localized radiorecurrence, sFT appears oncologically comparable to sRP at 10 years—with fewer perioperative complications. In an older, comorbid population, that therapeutic ratio is hard to ignore. | Light, JAMA Oncol 2026