Emerging focal ablation therapies for radio-recurrent prostate cancer: a comprehensive review of diagnostic imaging, ablative techniques, and patient outcomes

Prostate cancer is among the most common malignancies in men, with the majority of cases manifesting as localized disease. Standard treatment options include radiation therapy, radical prostatectomy, and active surveillance. Despite effective primary treatments, recurrence remains a clinical challenge, with limited salvage options that balance efficacy and side effects. Emerging focal ablative therapies for radio-recurrent prostate cancer represent a promising alternative for patients with biochemical recurrence following definitive radiation therapy, offering an option to avoid salvage prostatectomy or whole-gland re-irradiation. A comprehensive literature review was conducted using PubMed, Medline, and Cochrane databases to identify studies on focal ablative therapies for recurrent prostate cancer following radiation therapy. Search terms included “recurrent localized prostate cancer”, “high-intensity focused ultrasound”, “cryotherapy”, “irreversible electroporation”, and “photodynamic therapy”. Selected studies were evaluated based on outcomes and safety data relevant to salvage ablation. Advanced imaging techniques such as multiparametric MRI and prostate-specific membrane antigen positron emission tomography/computed tomography have improved the detection and localization of recurrent prostate cancer, facilitating precise delivery of ablative therapies. Preliminary evidence suggests that focal therapies may provide oncologic control similar to whole-gland treatments while reducing adverse effects. However, variability in functional outcomes, particularly concerning urinary and sexual health, underscores the need for careful patient selection and rigorous follow-up. Focal ablation therapies represent a promising option for recurrent prostate cancer, potentially enhancing the quality of life without compromising cancer control. Further research, especially randomized controlled trials, is necessary to establish their long-term safety and efficacy.

Ablation; Cryotherapy; High-intensity focal ultrasound; Irreversible electroporation; Photodynamic therapy; Prostate cancer; Recurrence

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