February 2026

The first-ever direct comparison of salvage focal therapy (sFT) and salvage radical prostatectomy (sRP) for localized radiorecurrent prostate cancer has been published in JAMA Oncology. Led by Alexander Light and Prof. Hashim Ahmed from Imperial College London, the international multicenter cohort study included 923 patients from 9 countries.

Patients whose prostate cancer recurs locally after prior radiotherapy face a particularly difficult clinical situation. While salvage radical prostatectomy has been an established treatment option, it is associated with considerable morbidity due to the tissue changes caused by previous radiation. Salvage focal therapy — including HIFU and cryotherapy — has emerged as a promising, less invasive alternative, but until now, no study had directly compared its long-term outcomes against radical surgery. Furthermore, outcomes for salvage focal therapy beyond 5 years had not been previously reported. The key findings from the propensity-matched analysis strongly support focal therapy as a highly effective treatment option with a significantly more favorable safety profile:

• 10-year cancer-specific survival was 92% for salvage focal therapy and 99% for salvage radical prostatectomy — a difference that was not statistically significant (P = .15).
• 10-year overall survival also showed no statistically significant difference between the two groups (P = .72).
• However, salvage radical prostatectomy was associated with dramatically higher complication rates: the adjusted odds of any complication were approximately 24 times higher, and the odds of a major complication (Clavien-Dindo grade 3–5) were approximately 9 times higher compared with salvage focal therapy.

Among the focal therapy patients, 77.6% were treated with HIFU and the remainder with cryotherapy. In the surgical group, 74.6% underwent open surgery and the remainder robot-assisted procedures.

The authors conclude that salvage focal therapy may provide a more favorable therapeutic ratio for many patients with localized radiorecurrent prostate cancer, offering comparable long-term cancer control with significantly fewer complications.

Prof. Mark Emberton, Professor of Surgery at University College London, Dean of Faculty at UCL, and a pioneer of HIFU-based focal therapy, commented on the significance of the publication: “This is a most important contribution to the literature that will help men make a decision at a time when decision making is particularly challenging for the individual. Hopefully it will result in earlier referral of the men who have a rising PSA following radiotherapy.”

In an invited editorial published alongside the study in JAMA Oncology, Dr. John Nikitas and Dr. Neha Vapiwala from the University of Pennsylvania’s Abramson Cancer Center further underscore the impact of these findings. They note that earlier identification and improved localization of radiorecurrent prostate cancer — together with more reliable imaging to rule out micrometastatic disease — are transforming salvage therapy decision-making.

This publication represents a major milestone for the field of focal therapy and provides the strongest evidence to date that salvage focal therapy — particularly using HIFU — offers long-term cancer control comparable to radical surgery, while sparing patients from the significant morbidity associated with salvage prostatectomy. These findings have important implications for clinical practice and shared decision-making for patients facing prostate cancer recurrence after radiotherapy.

Reference:
Light A, Peters M, Arya M, et al. Salvage Focal Therapy vs Radical Prostatectomy for Localized Radiorecurrent Prostate Cancer. JAMA Oncol. Published online February 12, 2026. doi:10.1001/jamaoncol.2025.6448

Invited Commentary:
Nikitas J, Vapiwala N. Redefining Salvage Therapy for Localized Radiorecurrent Prostate Cancer — In More Ways Than One. JAMA Oncol. Published online February 12, 2026. doi:10.1001/jamaoncol.2025.6079

Read more in JAMA Oncology: https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900