Abstract
INTRODUCTION: Prostate cancer is a prevalent malignancy with rising incidence rates globally. High-intensity focused ultrasound (HIFU) is a promising, minimally invasive treatment for localised prostate cancer. However, recurrence following HIFU, indicated by rising PSA levels or imaging-confirmed local recurrence, remains a concern. Salvage radiotherapy is a potential treatment for recurrent prostate cancer post-HIFU, but evidence on its efficacy and safety is limited. METHOD: This retrospective study evaluated eight patients with localised prostate cancer who underwent salvage radiotherapy following HIFU failure. Salvage treatment consisted of external beam radiation therapy (EBRT), delivered either as conventional fractionation (76 Gy in 38 daily fractions) or stereotactic ablative radiotherapy (36.25-40 Gy in five alternate-day fractions). Outcomes assessed included prostate-specific antigen (PSA) response, biochemical progression-free survival (bPFS), overall survival (OS) and treatment-related toxicity profiles. RESULTS: All eight patients experienced a significant decline in PSA levels, with no biochemical failures observed during a median follow-up of 72.4 months. The 5-year biochemical failure-free survival and overall survival rates were 100%. Among the eight patients, 6 (75%) had Grade 2 or lower genitourinary toxicity, and 5 (62.5%) had Grade 2 or lower gastrointestinal toxicity, with no Grade 3 or higher adverse events. DISCUSSION: Salvage EBRT after HIFU failure provides durable disease control with manageable side effects. Further research with larger cohorts is needed to refine treatment strategies for recurrent prostate cancer.