[Therapy options in relapsing prostate cancer after external radiation therapy]

In the near future, the number of young patients suffering from locoregional recurrence of their prostate cancer after external beam radiation will increase. For these patients, androgen deprivation is the most widely used therapy, but it is only palliative. Salvage radical prostatectomy, cryoablation, interstitial brachytherapy, and high-intensity focused ultrasound (HIFU) are treatment options with the potential of curing the patient. Currently, salvage radical prostatectomy offers the best chance for cure. Although a significant reduction in peri- and postoperative complication rates has been reported, surgery remains technically challenging, with a high rate of urinary incontinence. We believe that salvage prostatectomy should be considered only for patients in good general health whose life expectancy is more than 10 years and whose cancer was initially organ-confined before radiation therapy. Salvage cryotherapy might be an alternative to surgery. Complication rates have decreased as technical application has improved considerably within the last years. A major drawback of cryoablation is its lack of reliable and complete ablation of all prostate cells. HIFU and interstitial brachytherapy are minimally invasive salvage options that have been investigated in small clinical studies.