2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:Tb2c,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). To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Thirty-one studies (4525 patients) were identified that assessed salvage high-dose-rate brachytherapy (HDR-BT; 336 patients), low-dose-rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy.31:T10b5, Importance 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). Objective To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. Data Sources MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Study Selection Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. Data Extraction and Synthesis This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main Outcomes and Measures Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Results Thirty-one studies (4525 patients) were identified that assessed salvage high-dose–rate brachytherapy (HDR-BT; 336 patients), low-dose–rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Low-Dose-Rate Brachytherapy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Low-Dose-Rate Brachytherapy (modality). Clinician-written summaries and actionable practice insights. 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Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials.","abstract":"$30","keywords":[],"pubmed_id":"42060279","conclusions":"","publication_date":"2026-04-30T00:00:00"},"crossref":{"DOI":"10.1001/jamaoncol.2026.1023","URL":"https://doi.org/10.1001/jamaoncol.2026.1023","ISSN":["2374-2437"],"link":[{"URL":"https://jamanetwork.com/journals/jamaoncology/articlepdf/2848244/jamaoncology_miszczyk_2026_oi_260016_1776800868.0938.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Local Salvage Therapy Alone for Local Recurrence of Prostate Cancer After Radiotherapy"],"author":[{"given":"Marcin","family":"Miszczyk","sequence":"first","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria"},{"name":"Collegium Medicum, Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland"}]},{"given":"Federico","family":"Mastroleo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy"},{"name":"Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy"}]},{"given":"Anna","family":"Kujawska","sequence":"additional","affiliation":[{"name":"Department of Urology and Oncological Urology, Poznan University of Medical Sciences, Poznań, Poland"}]},{"given":"Adam","family":"Gurwin","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland"}]},{"given":"Giulia","family":"Marvaso","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy"},{"name":"Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy"}]},{"given":"Tamás","family":"Kói","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Budapest, Hungary"},{"name":"Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary"}]},{"given":"Giorgio","family":"Calleris","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Turin, Italy"}]},{"given":"Marnix","family":"Rasing","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"}]},{"given":"Joseph","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Urology, Western University, London Health Sciences Centre, London, Ontario, Canada"}]},{"given":"Donald","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, UNIO Healthcare Partners, San Diego, California"}]},{"given":"Arjun","family":"Nathan","sequence":"additional","affiliation":[{"name":"Division of Surgery and Interventional Science, University College London, London, England"},{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England"}]},{"given":"Max","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Radiotherapiegroep Deventer, Deventer, the Netherlands"}]},{"given":"Jochem","family":"van der Voort van Zyp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"}]},{"given":"Pocharapong","family":"Jenjitranant","sequence":"additional","affiliation":[{"name":"Department of Urology, Western University, London Health Sciences Centre, London, Ontario, Canada"}]},{"given":"George","family":"Hruby","sequence":"additional","affiliation":[{"name":"Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia"}]},{"given":"Timo F. 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Severe or worse adverse event rates varied by modality: LDR-BT 14%, salvage RP 13%, HDR-BT 5%, HIFU 5%, SBRT 4%, and cryotherapy 2%.","limitations":"- No randomized controlled trials exist in this evidence base, limiting causal inference.\n- Risk of bias was primarily driven by patient selection, meaning results apply only to well-selected patients.\n- No prospective studies were identified for salvage radical prostatectomy.","practice_takeaway":"For well-selected patients with local radiorecurrent prostate cancer who wish to avoid ADT, local salvage therapy alone is a viable option — over three-quarters remain ADT-free at 2 years and ~75% remain metastasis-free at 5 years. HDR-BT, HIFU, SBRT, and cryotherapy carry the lowest rates of severe toxicity (2–5%) and may be preferred when feasible."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Low-Dose-Rate Brachytherapy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Low-Dose-Rate Brachytherapy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Low-Dose-Rate Brachytherapy"}}}]]

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