Role of focal salvage ablative therapy in localised radiorecurrent prostate cancer

Up to one-third of men can fail radical external beam radiotherapy for primary prostate cancer. Most of these men have expectant management with delayed hormones. However, around half of these men have localised recurrence. Challenges remain in identifying such men accurately, in order to enable them to undergo local salvage therapy which is potentially curative. Currently, this includes radical prostatectomy, brachytherapy and ablative whole-gland therapies, such as cryotherapy and high intensity focused ultrasound, all of which can carry significant morbidity. New approaches may involve targeting the area of recurrence alone—focal salvage therapy—in order to reduce tissue damage and thus reduce morbidity. This requires accurate localisation of intraprostatic recurrent disease and precision targeted ablation.