In a systematic review and meta-analysis reported in JAMA Oncology, Miszczyk et al found that local therapies alone are associated with “reasonable efficacy” in select patients with locally radiorecurrent prostate cancer.
Study Details
A literature search through May 2025 was performed to identify prospective and retrospective studies that investigated local salvage therapies without concomitant systemic treatment for locally recurrent prostate cancer after definitive radiotherapy. Eligible studies provided data on androgen-deprivation therapy (ADT)–free survival or metastasis-free survival.
Key Findings
A total of 31 studies (4,525 patients) were identified that assessed salvage high-dose–rate brachytherapy (HDR-BT; 336 patients), low-dose–rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1,476 patients), cryotherapy (1,621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies involved 1,055 patients (approximately one-fourth of total population), with none involving sRP.
Pooled 2- and 5-year ADT-free survival among 2,887 patients was 76.8% and 55.2%, respectively. Pooled 2- and 5-year metastasis-free survival among 3,425 patients was 90.4% and 75.2%, respectively.
Rates of grade 3 or higher adverse events among 2,308 patients ranged from 14% in patients undergoing LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, to 2% for cryotherapy.
The investigators concluded: “The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent [prostate cancer]. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy.”
Shahrokh F. Shariat, MD, of Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Austria, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: The study was supported by grants from the National Cancer Institute and others. For full disclosures of the study authors, visit jamanetwork.com.
