Local prostate cancer recurrence after radiotherapy or brachytherapy. What now? Retrospective analysis of salvage prostatectomy and salvage cryoablation.

[INTRODUCTION AND OBJECTIVES] Local recurrence after radiotherapy for prostate cancer poses a significant clinical challenge, and the lack of robust comparative evidence limits clear therapeutic guidance. This study aimed to assess oncological outcomes of salvage radical prostatectomy (SRP) versus salvage cryoablation (SCA) in patients with localized radio-recurrent disease.

[MATERIALS AND METHODS] A retrospective, single-centre cohort study was conducted including hormone-sensitive prostate cancer patients with local recurrence after external beam radiotherapy or brachytherapy, treated between 2007 and 2024. The primary endpoint was biochemical recurrence-free survival (BCR-FS) at 3 and 5 years. Secondary endpoints included additional treatment-free survival (AT-FS), metastasis-free survival (MFS), and recurrence predictors. Kaplan-Meier and multivariate logistic regression analyses were performed.

[RESULTS] A total of 56 patients were included: 32 treated with SRP and 24 with SCA. Median follow-up was significantly longer in the SCA group (8.2 vs. 3.8 years, P < .05). BCR-FS at 3 and 5 years was 47% and 37% in the SCA group and 43% and 32% in the SRP group (P > .05). Five-year AT-FS was 40% (SCA) vs. 55% (SRP; P = .32), and MFS was 85% (SCA) vs. 83% (SRP; P = .92). A Gleason score ≥ 8 at recurrence was independently associated with higher risk of recurrence (OR 7.7; 95% CI: 1.3-47; P = .02).

[CONCLUSIONS] SRP and SCA showed similar oncological outcomes. Gleason ≥ 8 was the only factor related to poor outcomes. Given the low chance of cure after salvage therapies, SCA may be an adequate option in these patients.