Focal therapy (FT) is a minimally invasive approach for localized prostate cancer (PCa), but recurrence remains a significant challenge. This study evaluated the safety and efficacy of redo focal therapy (rFT) as a follow-up treatment for recurrent cases. A retrospective analysis was conducted on 48 patients who underwent rFT (either high-intensity focused ultrasound [HIFU] or cryotherapy) after a previous FT for low- and intermediate-risk PCa at a single high-volume European center between 2009 and 2018. The primary outcomes were failure-free survival (FFS), defined as post-rFT positive biopsy with ISUP grade 2 or higher, progression to whole-gland or systemic salvage treatments, development of PCa metastasis, and/or PCa-specific death, and treatment-free survival (TFS) concerning avoidance of radical treatments like prostatectomy, radiotherapy, or hormone therapy following rFT. Secondary outcomes were evaluated through multivariable Cox regression analysis (MVA) to assess the effect of PSA change (%ΔPSA, the ratio of PSA nadir to pre-rFT PSA) on these outcomes, with covariates including patient age, PSA levels, ISUP grade, biopsy core positivity, and treatment type.
Results indicated that 67% of patients initially underwent HIFU and 33% cryotherapy for FT, and for rFT, 71% underwent HIFU and 29% cryotherapy. Median PSA reduction post-rFT was 47%, with a follow-up median of 54 months. Recurrence occurred in 50% of patients, with infield recurrence in 58% of cases. Median FFS was 63 months, and TFS was 41 months, with two cases progressing to metastasis but no PCa-specific deaths. MVA revealed %ΔPSA as a significant independent predictor of FFS and TFS. Complications were low, with 19% experiencing minor adverse events (Clavien grade 1 or 2). This study suggests that rFT can offer an effective salvage option for recurrent PCa, potentially delaying the need for more aggressive treatments.
