Intra-prostatic Cancer Recurrence following Radical Radiotherapy on Transperineal Template Mapping Biopsy: Implications for Focal Ablative Salvage Therapy.

Men who fail external beam radiotherapy (EBRT) are usually placed on delayed hormone therapy. Some of these men have localised recurrence that might be suitable for further local therapy. We aimed to describe patterns of recurrence, and suitability for focal ablative therapy, in those undergoing transperineal template prostate-mapping (TTPM) biopsies.
145 consecutive patients (December 2007-May 2014) referred with suspicion of recurrence due to rising PSA after EBRT or brachytherapy who underwent TTPM-biopsies. Suitability for focal ablative therapy required the cancer to be either unifocal or unilateral, or bilateral/multifocal with one dominant index lesion and secondary lesions with Gleason score 3+3=6 with no more than 3mm cancer core involvement.
The mean age was 70.7 (SD 5.8) years. Median PSA at time of TTPM-biopsy was 4.5 (IQR 2.5-7.7). Overall, 75.9% (110/145) were suitable for a form of focal salvage treatment; 40.7% (59/145) were suitable for quadrant ablation, 14.5% (21/145) hemiablation, 14.5% (21/145) bilateral focal ablation and 6.2% (9/145) for index lesion ablation.
Three quarters of patients who have localised radio-recurrent prostate cancer may be suitable for focal ablative therapy to the prostate based on transperineal template prostate mapping biopsies.