How to cite: Marra G. Principles of focal salvage treatment for radiorecurrent prostate cancer – is it feasible? Grand Rounds in Urology.” September 15, 2025. Accessed Apr 2026. https://grandroundsinurology.com/principles-of-focal-salvage-treatment-for-radiorecurrent-prostate-cancer-is-it-feasible/
Summary
Giancarlo Marra, MD, Assistant Professor and Urological Surgeon, Città della Salute e della Scienza and University of Turin, Turin, Italy, examines focal salvage therapy for radiorecurrent prostate cancer, with a focus on feasibility and patient selection. He notes that historical outcomes with salvage radical prostatectomy included high morbidity with rectal injury and incontinence. Robotic approaches have reduced complications, yet functional outcomes remain imperfect, motivating interest in less invasive options.
Dr. Marra shares that modern imaging improves the localization of recurrence. Prostate-specific membrane antigen positron emission tomography (PSMA PET) and multiparametric magnetic resonance imaging (MRI) often identify disease confined to the prostate, frequently at the original index lesion. Pathology series indicate that a substantial proportion of cases are unifocal or localized, supporting targeted ablation in selected patients.
Dr. Marra notes that prospective studies, including FORECAST and FIRE, suggest that focal ablation can deliver comparable progression control to whole gland salvage with better preservation of continence and erectile function. Prostate-specific antigen (PSA) declines are common, and systemic therapy can often be deferred in the short term.
Dr. Marra states that clinical application centers on the rigorous selection of men with localized recurrence and a limited disease burden, the integration of imaging into planning, and a priority on quality of life. Focal salvage therapy is presented as a practical option between systemic therapy and radical salvage.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Giancarlo Marra, PhD, is an Assistant Professor at the University of Turin in Italy. Dr. Marra also serves as a urologist at the Molinette Hospital in Turin, Italy. He is a nationally and internationally recognized expert, in particular in the field of urological oncology, with a focus on prostate cancer. His focuses include treatments with high-intensity focused ultrasound, irreversible electroporation, and robotic surgery.
