How do you approach management of a patient with intermediate risk prostate cancer treated upfront with HIFU and intermittent ADT who is later found to have rising PSA and biopsy-proven prostate-confined recurrence?

These are frustrating situations, and ones I am now seeing frequently as focal therapies have gained traction in the United States. The approach, needless to say, is highly individualized. Often, these glands are quite abnormal in MRI appearance, and there is a concern for fibrosis. My approach is h...

I would treat him as a salvage as he has had treatment to his prostate gland. I would make sure that he does not have any evidence of lymph node/metastatic disease with an MRI scan of the pelvis and possibly a PSMA PET-CT scan.

For the treatment, I would recommend that the patient be treated with e...

RT if it’s local and or regional. Plus ADT, depending on path and extent.