Frontiers | Focal (Salvage) Treatment for Prostate Cancer

Editorial26 January 2024

Editorial: Focal (salvage) treatment for prostate cancer

Max Petersand Taimur T. Shah

In recent years, radiotherapy based salvage treatments have undergone significant developments. Salvage brachytherapy had already shown promising results in the whole gland and focal setting in terms of tumour control and toxicity (2)(3). Current focus has shifted towards, MRI-guided radiotherapy delivery with machines able to treat a variety of recurrent lesions. A nice overview of the possibilities is given by the case reports described in the paper of Montalvo et al. (4), where patients with recurrences both after radiotherapy and prostatectomy in several anatomical locations are described. It provides a glimpse of what the future of salvage MRI-guided re-irradiation has in store for us.Although external beam radiotherapy techniques have improved significantly over the last years, the steep dose falloff of brachytherapy carries advantages for surrounding organs at risk. Ménard and colleagues give us an overview on the use of focal salvage high dose rate (HDR) brachytherapy to the recurrent tumour area or as a boost in a whole-gland salvage setting. Although out of field recurrences might be slightly higher when targeting only the recurrent lesions, both approaches were associated with high biochemical (control) rates and no severe toxicity (although grade 2 genitourinary and gastrointestinal toxicity was higher when using a whole gland with boost approach). This led to stable quality of life in the described cohort.Whether a whole-gland or focal approach is warranted is addressed by King et al. in which they provide a method of choosing between the strategies. This risk-adapted paradigm enables clinicians to choose between focal or whole-gland salvage and is a great addition to the set of papers dealing with this issue (5).Brachytherapy is conventionally applied transperineally under ultrasound and more recently under MRI guidance. A new technique using transperirectal application under CT guidance with a personalised 3D-template is described by Di et al. (6). They name several circumstances and potential advantages of this technique.

1,663 views