Systematic review and meta-analysis of local salvage therapy alone for local recurrence of prostate cancer after radiotherapy

Standard-of-care management of radiorecurrent prostate cancer (PCa) involves systemic therapy; however, some patients seek to avoid the adverse events (AEs) that are associated with androgen deprivation therapy (ADT). Systematic review and meta-analysis of published studies evaluated outcomes of local therapy without systemic therapy for radiorecurrent PCa. In the literature up to May 2025. The authors identified 31 studies (4525 patients) of local salvage therapy alone (high-dose-rate brachytherapy, low-dose-rate brachytherapy, stereotactic body radiotherapy, radical prostatectomy, cryotherapy, high-intensity focused ultrasonography, or mixed methods). Pooled ADT-free survival rates at 2 years and 5 years were 76.8% and 55.2%, respectively. Pooled metastasis-free survival rates at 2 and 5 years were 90.4% and 75.2%, respectively. Rates of severe or worse AEs ranged from 2% to 14% depending on the treatment method. The authors conclude that local salvage therapies alone have reasonable efficacy in well-selected patients with local recurrence of PCa after radiotherapy who wish to avoid ADT.