Redefining Salvage Therapy for Localized Radiorecurrent Prostate Cancer—In More Ways Than One
Menée à l'aide de données multicentriques portant sur 554 patients atteints d'un cancer de la prostate localisé récidivant après radiothérapie, cette étude compare l'efficacité, du point de vue de la survie spécifique à 10 ans et de la survie globale, d'une prostatectomie radicale et d'une prostatectomie de rattrapage par ultrasons focalisés de haute intensité ou par cryothérapie
The term salvage therapy, while commonplace among medically trained individuals, can imply a dire situation with limited hope for patients, a final rescue against all odds. Thankfully, earlier identification and improved localization of radiorecurrent prostate cancer (together with more reliable imaging to rule out micrometastatic disease) are transforming how we approach salvage therapy decision-making and the success we expect in disease control and quality of life. For patients presenting with isolated local recurrences, treatment options focused on targeting known disease are often more durable and appealing than nonspecific systemic therapy (ie, androgen deprivation therapy [ADT] alone). Due to tissue changes after radiotherapy (RT), there are well-established concerns about the long-term morbidity of salvage radical prostatectomy (RP), prompting the near ubiquitous adage that “once you have radiotherapy, you cannot have surgery afterward.” A relative dearth of data comparing RP with less invasive focal therapies, like high-intensity focused ultrasonography (HIFU) or cryotherapy, has in turn limited evidence-based clinical guidance in the salvage setting. In this issue of JAMA Oncology, Light et al provide some welcome clarity on this issue.
JAMA Oncology , éditorial, 2026