Authors' objectives: To identify and summarise evidence that addresses the following question: What is the clinical and cost effectiveness of salvage high-dose-rate brachytherapy (HDR-BT) compared to radical prostatectomy or stereotactic body radiotherapy (SABR) for local or locally advanced relapse of prostate cancer after prior curative radiotherapy?

Authors' results and conclusions: The evidence included in this review suggests that salvage high-dose-rate brachytherapy (HDR-BT) can be safely used as a treatment for local and locally advanced relapse of prostate cancer after curative radiotherapy. Exploratory analysis of single arm case series indicated that relapse free survival rates for HDR-BT were comparable with salvage prostatectomy and salvage SABR and that rates of severe genitourinary and gastrointestinal side effects were lower for salvage HDR-BT than for salvage radical prostatectomy. However, lack of direct comparative evidence between salvage HDR-BT, salvage SABR and salvage prostatectomy and unknown differences between participants and adjuvant therapies, means that conclusions about which treatment produces better outcomes are uncertain. No health economic studies were identified. The development of a new economic analysis was considered; however, it was determined that the effectiveness evidence was insufficient to use for a robust evaluation.

Authors' recommendations: More evidence is needed on salvage high-dose-rate brachytherapy for local or locally advanced relapse of prostate cancer after prior curative intent radiotherapy.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Panel agreed that more studies comparing salvage HDR-BT to other salvage treatments are needed. And more data on patient reported outcomes and survival outcomes after HDR-BT are needed.

Project Status: Completed

Year Published: 2026

URL for published report: https://healthtechnology.wales/reports-guidance/salvage-high-dose-rate-brachytherapy-hdr-bt/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk