title: Salvage local therapy for radiation-recurrent prostate cancer - where are we?
abstract: BACKGROUND
  Prostate cancer is the most frequent cancer among males in Europe and a leading cause of cancer deaths, with similar proportion in other developed countries. For more than twenty years, external-beam radiation therapy, alongside with radical prostatectomy, has been used as a primary radical therapeutic approach for localized prostate cancer. Yet, EBRT failures relate to 22-69% following curative radiotherapy (± androgen deprivation therapy). Additionally, a proportion of these men will have a biopsy-proven local recurrence.
  
  
  METHODS
  The Medline and Web of Science databases were searched without a time limit during March 2016 using the terms 'prostate cancer' in conjunction with 'radiotherapy', 'recurrence', 'biochemical', 'salvage', 'brachytherapy', 'prostatectomy', 'HIFU', 'cryotherapy' and 'focal'. The search was limited to the English, Polish, German and Spanish literature.
  
  
  RESULTS
  Currently, salvage treatment after failed radiotherapy includes radical prostatectomy, brachytherapy and ablative whole-gland therapies, such as cryotherapy and high intensity focused ultrasound. New approaches, so called focal salvage therapy, involve ablation of only the zone of recurrence in order to decrease tissue injury and therefore to diminish morbidity.
  
  
  CONCLUSIONS
  At present no authoritative recommendations can be concluded because of the absence of randomized data with standardized definitions and protocols. Nevertheless, we believe that local salvage treatment should be at least considered in patients after biochemical relapse following radiotherapy.
authors.affiliation: Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland.
authors.forename: Romuald
authors.initials: R
authors.lastname: Zdrojowy
authors.affiliation: Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Dembowski
authors.affiliation: Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Małkiewicz
authors.affiliation: Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Tupikowski
authors.affiliation: Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Krajewski
keywords: biochemical recurrence; prostate cancer; radiotherapy; salvage