前列腺癌的局部前列腺内放射性复发（IPR-PC）可能与侵袭性自然史相关，并影响长期的疾病特异性生存。虽然适当的局部挽救干预可以起到治愈作用，但前列腺内复发的检查和局部挽救的最佳实践尚不清楚。美国镭协会 (ARS) 泌尿生殖系统适当使用标准委员会寻求制定基于证据的建议来解决这一差距。对 PubMed 和 Embase 进行了搜索，检索了一组全面的相关同行评审文章，涉及与放射科检查和治疗相关的四个主题。 IPR-PC。三名研究人员对文献进行了评估和总结，并为四个主题中的每一个创建了临床变体。 ARS 泌尿生殖 AUC 多学科专家小组投票选出了每种变体的最合适程序，并使用修改后的德尔菲法来总结建议。专家小组得出的结论是，通过前列腺特异性膜抗原正电子发射断层扫描 (PSMA PET) 和多参数磁学进行放射学分期应进行磁共振成像以排除患有转移性疾病的患者并确定放射复发的局部范围。在局部抢救之前需要进行活检，以避免放射学复发代表治疗效果的患者出现过度毒性。尽管共同决策至关重要，但优先考虑局部挽救，而不是单独进行非治疗性激素控制。建议采用挽救性再照射方法来限制毒性。当寻求放射治疗挽救时，激素治疗可能有利于放射增敏，但持续时间很短，并且经典的雄激素剥夺疗法优于新型激素药物。尽管与全腺体挽救相关的毒性似乎是非常可以忍受的，但当可以通过多种放射线照相和组织采样方式确认病灶复发的可信度时，应进行病灶挽救。存在几种放射治疗挽救方案，其中大多数可以分六次或更少的分次进行。本指南的数据仅限于在 PSMA PET 时代之前最初接受传统分割外照射放疗并进行复发检查的个体。本共识指南为 IPR-PC 的检查和治疗的适当程序提供了基于证据的指导。我们迫切期待丰富这些指南的前瞻性证据。我们总结了放射治疗后前列腺癌局部复发患者的最佳检查和治疗的证据。专家小组评估了之前的研究，并对应该执行和应该避免的程序进行了投票。该指南是一个有用的工具，可帮助医生讨论最佳治疗方案，最大限度地提高治愈机会，同时最大限度地减少副作用。由 Elsevier B.V. 出版。

Local intraprostatic radiorecurrence of prostate cancer (IPR-PC) can be associated with an aggressive natural history and impact long-term disease-specific survival. While appropriate local salvage intervention can be curative, best practices for workup and local salvage of intraprostatic recurrence are poorly defined. The American Radium Society (ARS) Genitourinary Appropriate Use Criteria Committee sought to develop evidence-based recommendations to address this gap.PubMed and Embase were searched to retrieve a comprehensive set of relevant peer-reviewed articles on four topics relevant to the workup and treatment of IPR-PC. The literature was evaluated and summarized by three investigators, and clinical variants were created for each of the four topics. The ARS Genitourinary AUC multidisciplinary expert panel voted on the most appropriate procedures for each variant, and a modified Delphi approach was used to summarize recommendations.The panel concluded that radiographic staging via prostate-specific membrane antigen positron emission tomography (PSMA PET) and multiparametric magnetic resonance imaging should be performed to exclude patients with metastatic disease and identify the local extent of radiorecurrence. Biopsy is required before local salvage to avoid excessive toxicity in patients whose radiographic recurrence represents a treatment effect. Consideration of local salvage is preferred in lieu of noncurative hormonal manipulation alone, although shared decision-making is critical. Salvage reirradiation approaches are recommended to limit toxicity. Hormonal therapy may be beneficial for radiosensitization when radiotherapeutic salvage is pursued, but only of short duration, and classic androgen deprivation therapies are preferred over novel hormonal agents. Focal salvage should be pursued when confidence in focal recurrence can be confirmed via multiple radiographic and tissue sampling modalities, although the toxicity associated with whole-gland salvage appears to be very tolerable. Several radiotherapeutic salvage regimens exist, most of which can be carried out in six or fewer fractions. The data informing this guideline are limited to individuals initially treated with conventionally fractionated external beam radiotherapy and with workup for recurrence before the PSMA PET era.This consensus guideline provides evidence-based guidance on the appropriate procedures for workup and treatment of IPR-PC. Prospective evidence to enrich these guidelines is eagerly anticipated.We summarize evidence for the best workup and treatment for patients with local recurrence of prostate cancer after radiotherapy. A panel of experts evaluated previous studies and voted on the procedures that should be performed and those that should be avoided. This guideline is a useful tool for helping doctors to discuss the best treatment options that maximize the chance of cure while minimizing side effects.Published by Elsevier B.V.