Whether focal therapy (FT) for prostate cancer (PC) jeopardizes outcomes from salvage treatments is a matter of debate still to be resolved.

To review the literature on oncological and functional outcomes and complications for available treatment options for recurrent or residual PC after primary FT.

We performed a nonsystematic search of PubMed for articles assessing relevant outcomes for salvage local treatment after FT failure using a manual search. When no evidence could be extracted for the FT domain, records dealing with recurrence after whole-gland ablation were considered.

Four retrospective series assessed salvage treatments after FT failure evaluating cases of radical prostatectomy (RP) and repeat ablation (sample size from 12 to 22 patients). The quality of the studies was low, with a high risk of bias. Other options are radiation therapy (RT) and whole-gland or focal repeat ablations, although these have only been described after whole-gland ablation. With some exceptions, including sexual function for RP, overall complications and oncological and functional outcomes do seem to be acceptable and are not much worse than those in the primary setting. Important limitations include the low level of the evidence and the absence of standardized criteria for FT, salvage treatment, and FT failure.

Current evidence shows acceptable outcomes for post-FT salvage options, although this is based on retrospective data. While it seems that FT has a minimal impact on salvage treatment results, prospective controlled studies are needed to confirm these preliminary data.

We performed a literature search to determine the treatment options available for prostate cancer after failure of focal therapy and their outcomes. Options include radical prostatectomy, repeat whole-gland ablation, focal ablation, and radiotherapy. Overall cancer control, impacts on urinary and sexual function, and complications seem slightly worse but not markedly different compared to primary treatments, but high-quality studies are awaited to confirm these findings.

European urology oncology. 2019 Apr 15 [Epub ahead of print]

Giancarlo Marra, Massimo Valerio, Mark Emberton, Axel Heidenreich, Juanita M Crook, Alberto Bossi, Louis L Pisters

Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy. Electronic address: ., Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Division of Surgery and Interventional Science, University College London, London, UK., Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany., Department of Surgery, Division of Radiation and Developmental Radiotherapeutics, University of British Columbia, BC Cancer Center for the Southern Interior, Kelowna, Canada., Department of Urology, Gustave Roussy Cancer Institute, Villejuif, France., Department of Urology, MD Anderson Cancer Center, TX, USA.