What is your approach to patients with locally recurrent prostate cancer following cryotherapy or HIFU?

Limited data has been published on this subject, however, the best results from a standpoint of disease control and side effect profile have been observed with salvage radiotherapy. In general, our practice has been to treat these patients with definitive radiation to doses of 70-74 Gy. For patients with high risk features, we have added ADT and in some cases pelvic nodal irradiation. Post-cryo/HIFU patients are at higher risk of grade 3 GU toxicity associated with urethral stricture, similar to patients with prior TURPs, compared with patients being treated with EBRT upfront. Consequently, we have utilized slightly lower doses of radiation in the salvage setting (70-74 Gy) than we would in patients being seen for upfront definitive treatme...