Citations 2
Salvage Focal Therapy vs Radical Prostatectomy for Localized Radiorecurrent Prostate Cancer
Light, Alexander, Peters, Max, Arya, Manit, Tanaka, Mariana Bertoncelli , Dudderidge, Tim , Emberton, Mark, Grey, Alistair , Hindley, Richard, Laniado, Marc, McCraken, Stuart, Moore, Caroline M., Nigam, Raj , Noureldin, Mohamed , Reddy, Deepika, Virdi, Jaspal, Ahmed, Mohamed, Albisinni, Simone, Cathcart, P. , Joniau, S., Karnes, Robert Jeffrey, Persad, Raj , Rajwa, Paweł, Sanchez-Salas, Rafael, Shariat, Shahrokh F., Smith, Joseph A., Tilki, Derya, Poel, H. G. van der, Calleris, Giorgio , Gontero, P., Marra, Giancarlo, Ahmed, Hashim U., Joniau, Steven , Emberton, Mark , Rajwa, Paweł , Moore, Caroline M. , Joniau, Steven , Rajwa, Pawel , Light, Alexander J. W., Peters, Max , Emara, Amr M. , Moore, Caroline , Orczyk, Clément , Reddy, Deepika , Albisinni, Simone , Karnes, R. Jeffrey , Shariat, Shahrokh F. , Tilki, Derya , Poel, HG van der, Marra, Giancarlo , Ahmed, Hashim U. , Shah, Taimur Tariq
JAMA Oncology | February 12, 2026 | Volume: 12 | Issue: 4 | Pages: 364
Importance Patients with recurrent prostate cancer after previous radiotherapy typically have poor survival. Those with recurrences prostate confined might be suitable for salvage focal therapy (sFT) or salvage radical prostatectomy (sRP). sFT may offer good cancer control with comparatively less toxic effects, but outcomes beyond 5 years have not been reported, and no study has compared sFT to sRP. Objective To compare cancer control and perioperative complications among patients after sFT vs sRP. Design, Setting, and Participants In this international, multicenter cohort study of matched comparison data, patients undergoing sFT were derived from the prospective UK HIFU (high-intensity focused ultrasound) Evaluation and Treatment and International Cryotherapy Evaluation registries (9 centers; 2006-2024) and the prospective UK Focal Recurrent Assessment and Salvage Treatment cohort study (6 centers; 2014-2018). Patients undergoing sRP were derived from an international retrospective registry (12 centers in 8 countries; 2000-2021). Patients with biopsy-confirmed, localized recurrent prostate cancer postradiotherapy, either external beam radiotherapy, brachytherapy, or both, were included. Data were analyzed from March to July 2025. Exposures sFT using HIFU or cryotherapy vs sRP. Main Outcomes and Measures The primary outcome was cancer-specific survival up to 10 years. Secondary outcomes were overall survival, any perioperative complications (Clavien-Dindo grades 1-5), and major perioperative complications (Clavien-Dindo grades 3-5). Comparisons were made on matched patients following 1:1 cardinality matching within individual multiply-imputed datasets. Matching variables used were radiotherapeutic treatment, years between primary and salvage treatments, European Association of Urology recurrence risk group, and presalvage age, prostate-specific antigen, prostate volume, grade group, T stage, and androgen-deprivation therapy use. Results A total of 923 patients were eligible for matching (419 undergoing sFT and 504 undergoing sRP). Of the patients undergoing sFT, 325 (77.6%) underwent HIFU and the remainder cryotherapy, with 241 (57.5%) treated with quadrant ablation. Of patients treated with sRP, 376 (74.6%) underwent open surgery and the remainder robot-assisted surgery. For sFT vs sRP, 10-year cancer-specific survival was 92% (95% CI, 86%-98%) vs 99% (95% CI, 97%-100%), with no statistically significant difference (restricted mean time lost, −0.09 years; 95% CI, −0.22 to 0.03 years; P = .15; subdistribution hazard ratio, 0.45; 95% CI, 0.05-4.00; P = .47). There was no statistically significant difference in 10-year overall survival (restricted mean survival time, −0.13 years; 95% CI, −0.86 to 0.60 years; P = .72). Undergoing sRP was associated with statistically significant higher odds of any complication (adjusted odds ratio, 24.20; 95% CI, 12.94-45.27; P < .001) and major complication (adjusted odds ratio, 9.31; 95% CI, 3.42-25.36; P < .001). Conclusions and Relevance In this cohort study, sFT and sRP were effective for treating localized radiorecurrent prostate cancer, while sFT was associated with fewer perioperative complications. sFT may provide a favorable therapeutic ratio for many patients with localized radiorecurrent prostate cancer.
Biparametric vs Multiparametric MRI for Prostate Cancer Diagnosis
Ng, Alexander , Asif, Aqua , Gómez‐Gómez, Enrique , Budäus, Lars, Barrett, Tristan , Radtke, Jan Philipp , Kesch, Claudia, Pham, Tho, Tewari, Ash , Cabello, M.A. Rodríguez , Mynderse, Lance A. , Borghi, Marcelo, Boesen, Lars , Singh, Paras B. , Renard‐Penna, Raphaële , Leow, Jeffrey J. , Pecoraro, Martina , Giannarini, Gianluca , Perlis, Nathan , López-Ruiz, Daniel, Rossiter, Marimo , Khetrapal, Pramit , Chan, Vinson Wai‐Shun , Haider, Aiman , Clarke, Caroline S. , Dickinson, Louise , Mitra, Anita, Margolis, Daniel J. A., Takwoingi, Yemisi , Emberton, Mark , Allen, Clare, Moore, Caroline M. , Kasivisvanathan, Veeru , Collaborators, PRIME Study Group, Briganti, Alberto , Evangelista, Alex, Freeman, Alex , Kirkham, Alex, Zlotta, Alexandre R. , Grey, Alistair, Ryan, Andrew, Borrelli, Antonella , Andrews, Antonette, Finelli, Antonio , Sancho, Arturo Platas, Baring, Ashley, Roy, Ashoke, Issa, Balqiisa, Israël, Bas , González, Carolina Aulló, English, Caroline, Zuiani, Chiara , Amate, Cristina, Yong, Daniel , Rozze, Davide, Lomas, Derek J. , Cannoletta, Donato , Chang, Eileen Wang, Chun, Felix, Zussino, Gaia , Antoch, Gerald , Gandaglia, Giorgio, Sauter, Guido , Thevarajah, Harini, Sorrell, Harriet, McBain, Hazel, Reis, Henning , Pita, Hernando Ríos , Potyka, Ingrid , Collavino, Jeanlou, Koshy, Jincy, Weng, Jing Yi , Withington, John, Egmond, Joke van, Piper, Jon, O’Brien, Jonathan , Rosa, José Valero, Sanz, Juan Luis , Quesada, Juan Mesa, Jannusch, Kai , Corr, Kateri , Haines, Kenneth, Umutlu, Lale , Quarta, Leonardo, Casarotto, Letizia, Gimeno, Linda , Moretti, Lucas, Laschena, Ludovica , Drewes, Lukas, Ostos, Manuel Sanchez, Peris, M., Volpacchio, Mariano , Prentice, Mark, Graefen, Markus , Soligo, Matteo, Boschheidgen, Matthias , Singhera, M., Wenzel, Mike, Fatterpekar, Monali, Al‐Nader, Mulham , Kachanov, Mykyta , Shaida, Nadeem , Muirhead, Nicola , Vasdev, Nikhil , Sanmugalingam, Nimalan , Nørgaard, Nis , Vicente, Pete, Incze, Peter , Ryan, Philip, Rouvier, Philippe , Mead, Phoebe, Mozer, Pierre, Viana, Públio César Cavalcante , Jiménez, Rafael E. , Novotta, Réka, Huang, Richard, O’Sullivan, Richard, Jepsen, Rikke Karlin , Frese, Robert, Clow, Rosemary, Al‐Monajjed, Rouvier , Lewis, Sara , Cashman, Sophia, Pizzolitto, Stefano, Lelie, S., Lindner, Sydney, Al‐Hammouri, Tarek , Sánchez, Teresa González, Reid, Thomas, McClure, Timothy, Maurer, Tobias , Peruzzi, Valeria, Tan, Wei Phin, Nahas, William Carlos, Chong, Yew Lam, Agarwal, Ridhi , Panebianco, Valeria , Girometti, Rossano , Ghai, Sangeet , COBELLI, Francesco DE , Pham, Tho, Taneja, Samir S. , Hu, Jim C. , Dias, Adriano Basso , Falkenbach, Fabian , Kastner, Christof , Schimmöller, Lars , Nathan, Arjun , Punwani, Shonit , Brew‐Graves, Chris , Brembilla, Giorgio , Margolis, Daniel , Giganti, Francesco , Collaborators, PRIME Study Group, Crestani, Alessandro , Sciarra, Alessandro , Evangelista, Alex, Kirkham, Alex P. S. , Grey, Alistair, Blanca, Ana , Bjartell, Anders , Tong, Angela , Warren, Anne Y. , Ciardi, Antonio , Rannikko, Antti , Stabile, Armando , Villers, Arnauld A. , Issa, Balqiisa, Hadaschik, Boris Alexander , English, Caroline L, Lee, Chau Hung , Caris, Christien T.M. , Stempel, Conrad von , Rozze, Davide, Messina, Emanuele , Chun, Felix, Gandaglia, Giorgio, Robert, G. , Caglič, Iztok , Theysohn, Jens Matthias , Grummet, Jeremy , Koshy, Jincy, Wilkinson, John, Withington, John, Egmond, Joke van, Deeks, Jonathan J , O'Brien, Jonathan, Quesada, Juan Mesa, Quarta, Leonardo , Orecchia, Luca , Moretti, Lucas, Rooij, Maarten de , Bicchetti, Marco , Gatti, Marco , Peris, María de los Desamparados Esteban, Roethke, Matthias Claudius , Monte, Maurizio Del, Wenzel, Mike, Takahashi, Naoki , Fleshner, Neil , Albers, Peter , Mead, Phoebe, Visschere, Pieter De , Huang, Richard, Shah, Syed Ahmar , Sanchez, Teresa González, Bathala, Tharakeswara K , Kwast, Theodorus van der , Reid, Thomas, Løgager, Vibeke , Prabhu, Vinay , Wagaskar, Vinayak Gorakhnath , Tan, Wei Phin, Nahas, William Carlos, Witjes, Wim P.J. , Chong, Yew Lam
JAMA | September 10, 2025 | Volume: 334 | Issue: 13 | Pages: 1170
Importance Multiparametric magnetic resonance imaging (MRI), with or without prostate biopsy, has become the standard of care for diagnosing clinically significant prostate cancer. Resource capacity limits widespread adoption. Biparametric MRI, which omits the gadolinium contrast sequence, is a shorter and cheaper alternative offering time-saving capacity gains for health systems globally. Objective To assess whether biparametric MRI is noninferior to multiparametric MRI for diagnosis of clinically significant prostate cancer. Design, Setting, and Participants A prospective, multicenter, within-patient, noninferiority trial of biopsy-naive men from 22 centers (12 countries) with clinical suspicion of prostate cancer (elevated prostate-specific antigen [PSA] level and/or abnormal digital rectal examination findings) from April 2022 to September 2023, with the last follow-up conducted on December 3, 2024. Interventions Participants underwent multiparametric MRI, comprising T2-weighted, diffusion-weighted, and dynamic contrast–enhanced (DCE) sequences. Radiologists reported abbreviated biparametric MRI first (T2-weighted and diffusion-weighted), blinded to the DCE sequence. After unblinding, radiologists reported the full multiparametric MRI. Patients underwent a targeted biopsy with or without systematic biopsy if either biparametric MRI or multiparametric MRI was suggestive of clinically significant prostate cancer. Main outcomes and measures The primary outcome was the proportion of men with clinically significant prostate cancer. Secondary outcomes included the proportion of men with clinically insignificant cancer. The noninferiority margin was 5%. Results Of 555 men recruited, 490 were included for primary outcome analysis. Median age was 65 (IQR, 59-70) years and median PSA level was 5.6 (IQR, 4.4-8.0) ng/mL. The proportion of patients with abnormal digital rectal examination findings was 12.7%. Biparametric MRI was noninferior to multiparametric MRI, detecting clinically significant prostate cancer in 143 of 490 men (29.2%), compared with 145 of 490 men (29.6%) (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points; P = .50). Biparametric MRI detected clinically insignificant cancer in 45 of 490 men (9.2%), compared with 47 of 490 men (9.6%) with the use of multiparametric MRI (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points). Central quality control demonstrated that 99% of scans were of adequate diagnostic quality. Conclusion and relevance In men with suspected prostate cancer, provided image quality is adequate, an abbreviated biparametric MRI scan, with or without targeted biopsy, could become the new standard of care for prostate cancer diagnosis. With approximately 4 million prostate MRIs performed globally annually, adopting biparametric MRI could substantially increase scanner throughput and reduce costs worldwide. Trial registration ClinicalTrials.gov Identifier: NCT04571840