Salvage brachytherapy for recurrent prostate cancer after radiotherapy: An expert-endorsed review by uroGEC

Abstract

Radiorecurrent prostate cancer remains a challenging clinical scenario. Salvage brachytherapy, either low-dose-rate (LDR) or high-dose-rate (HDR), offers a promising organ-preserving option in carefully selected patients. This narrative review, endorsed by the uroGEC (Urology - Groupe Européen de Curiethérapie), summarizes current evidence, indications, techniques, outcomes, and limitations of SBT in men with local recurrence after primary radiotherapy. Patient selection is critical and should be based on rigorous restaging, including multiparametric MRI and/or PSMA PET, as well as histological confirmation of local recurrence. Focal BT, guided by imaging and targeting only the recurrent lesion, has emerged as a feasible and less toxic alternative to whole-gland re-irradiation. Reported biochemical control rates range between 50-70 % at 5 years, with acceptable genitourinary and gastrointestinal toxicity profiles, particularly when advanced imaging and modern brachytherapy techniques are used. Despite promising results, the evidence remains limited by small, heterogeneous cohorts and lack of prospective randomized trials. The uroGEC expert panel advocates for multidisciplinary decision-making, standardized protocols, and patient inclusion in clinical trials to better define the role of BT. In conclusion, BT represents a valuable salvage option in well-selected patients with localized recurrence, and should be considered in the context of individualized, image-guided treatment strategies.

Keywords: Focal re-irradiation; Image-guided therapy; Radio-recurrent prostate cancer; Salvage brachytherapy.