Salvage brachytherapy for recurrent prostate cancer after radiotherapy: An expert-endorsed review by uroGEC

Gomez-Iturriaga A, Tselis N, Willisch P, Guix B, Buchser D, Chyrek A, Monge RM, Strnad V, Wojcieszek P, Hoskin P, Strouthos I (2025)

Publication Type: Journal article, Review article

Publication year: 2025

Journal

Radiotherapy and Oncology Elsevier

Book Volume: 210

Article Number: 111042

DOI: 10.1016/j.radonc.2025.111042

Abstract

Radiorecurrent prostate cancer remains a challenging clinical scenario. Salvage brachytherapy, either low-dose-rate (LDR) or high-dose-rate (HDR), offers a promising organ-preserving option in carefully selected patients. This narrative review, endorsed by the uroGEC (Urology – Groupe Européen de Curiethérapie), summarizes current evidence, indications, techniques, outcomes, and limitations of SBT in men with local recurrence after primary radiotherapy. Patient selection is critical and should be based on rigorous restaging, including multiparametric MRI and/or PSMA PET, as well as histological confirmation of local recurrence. Focal BT, guided by imaging and targeting only the recurrent lesion, has emerged as a feasible and less toxic alternative to whole-gland re-irradiation. Reported biochemical control rates range between 50–70 % at 5 years, with acceptable genitourinary and gastrointestinal toxicity profiles, particularly when advanced imaging and modern brachytherapy techniques are used. Despite promising results, the evidence remains limited by small, heterogeneous cohorts and lack of prospective randomized trials. The uroGEC expert panel advocates for multidisciplinary decision-making, standardized protocols, and patient inclusion in clinical trials to better define the role of BT. In conclusion, BT represents a valuable salvage option in well-selected patients with localized recurrence, and should be considered in the context of individualized, image-guided treatment strategies.

Authors with CRIS profile

Vratislav Strnad Department of Radiation Oncology

Involved external institutions

Osakidetza ES Spain (ES) Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE) Hospital do Meixoeiro ES Spain (ES) Wielkopolskie Centrum Onkologii (WCO) / Greater Poland Cancer Centre PL Poland (PL) Clínica Universidad de Navarra ES Spain (ES) Maria Skłodowska-Curie Institute of Oncology / Centrum Onkologii–Instytut im. Marii Skłodowskiej-Curie w Warszawie PL Poland (PL) Christie NHS Foundation Trust GB United Kingdom (GB) Medical Institute for Radiation Oncology / Insituto Médico de Onco-Radioterapia (IMOR) ES Spain (ES)

How to cite

APA:

Gomez-Iturriaga, A., Tselis, N., Willisch, P., Guix, B., Buchser, D., Chyrek, A.,... Strouthos, I. (2025). Salvage brachytherapy for recurrent prostate cancer after radiotherapy: An expert-endorsed review by uroGEC. Radiotherapy and Oncology, 210. https://doi.org/10.1016/j.radonc.2025.111042

MLA:

Gomez-Iturriaga, Alfonso, et al. "Salvage brachytherapy for recurrent prostate cancer after radiotherapy: An expert-endorsed review by uroGEC." Radiotherapy and Oncology 210 (2025).

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