Salvage Treatment Following Focal Therapy

As focal therapy for prostate cancer becomes more common, it will become the potential need for managing recurrences. Identifying those with suspected recurrence will be the first step accomplished through laboratory evaluation, imaging, and biopsy. While current evidence is limited, options described for management include active surveillance, repeat focal therapy, radical prostatectomy, and radiation therapy. Active surveillance may be most appropriate in patients with low-grade, indolent recurrence. Repeated focal therapy may be offered in those with isolated but clinically significant recurrences. In those with multifocal or high-grade recurrence, transitioning to radical therapy with prostatectomy or radiation may be most appropriate. Ultimately, an assessment of individual risk and a shared decision-making discussion is essential to determine the optimal course of action.