Management strategies for radio-recurrent prostate cancer: a comprehensive review

Radiation- (radio-)recurrent prostate cancer poses a significant challenge in clinical management due to its complexity and varied treatment responses. The recurrence of prostate cancer following radiotherapy necessitates a nuanced management strategy that considers disease stage and aggressiveness, patient health status, and prior treatment modalities. Androgen deprivation therapy (ADT), a cornerstone in the management of regional or distant relapse, often initiates the therapeutic cascade, effectively suppressing tumor growth by targeting androgen signaling. Second-line antiandrogen therapies such as abiraterone and enzalutamide, in conjunction with ADT, exhibit considerable clinical efficacy by delaying disease progression and ameliorating symptoms. However, in the absence of regional or distant disease, local relapse after radiation may be best managed with local salvage therapy. Salvage radical prostatectomy (SRP) may be considered in select cases of local recurrence, providing a potentially curative option. Salvage radiation therapy (RT), such as stereotactic body RT (SBRT), low-dose-rate (LDR), or high-dose-rate (HDR) brachytherapy (BT) is another viable option for localized recurrences. Other local treatments, such as cryotherapy, high-intensity focused ultrasound (HIFU) and irreversible electroporation (IRE) have been applied as salvage local therapy for radio-recurrent prostate cancer with promising results. Notwithstanding, exploring new avenues for improved outcomes and personalized treatment strategies as well as clinical trials investigating novel therapeutic agents and combination therapies remain imperative for these men. This comprehensive review aims to examine the current landscape of therapeutic approaches and emerging strategies for managing radio-recurrent prostate cancer.