Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the Literature

Ploussard, Guillaume; Alméras, Christophe; Briganti, Alberto; Giannarini, Gianluca; Hennequin, Christophe; Ost, Piet; Renard-Penna, Raphaële; Salin, Ambroise; Lebrét, Thierry; Villers, Arnauld; Soulié, M.; Taille, Alexandre de la; Flamand, V.

doi:10.1016/j.juro.2015.04.103

Cited by 83 publications

(50 citation statements)

References 29 publications

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“…Additionally, we are not advocating specific salvage modalities, as choice of salvage therapy is dependent on prior radiation fields and patient/provider preference. Rather, our assertion is that there is growing evidence of the role of salvage therapy for select patients with recurrent CaP [27,28]. Furthermore, we were unable to include survival data as it was beyond the scope of the present analysis and limited by the short follow-up duration.…”

Section: Discussionmentioning

confidence: 95%

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

et al. 2017

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Background Management of recurrent prostate cancer (CaP) after radiotherapy (RT) is dependent on accurate localization of the site of recurrent disease. Objective To describe the anatomic patterns and clinical features associated with CaP recurrence following RT identified on advanced imaging. Design, setting, and participants Retrospective review of 184 patients with a rising prostate-specific antigen (PSA) after RT for CaP. Intervention C-11 choline positron emission tomography/computed tomography (CholPET). Outcome measurements and statistical analysis Recurrence patterns were classified as pelvic soft tissue only (as a surrogate for potentially salvageable disease) versus any extrapelvic disease, and clinical features were compared between patterns. Multivariable logistic regression was used to generate a predictive nomogram for extrapelvic recurrence. Discrimination was assessed with a c-index. Results and limitations Recurrence site was identified in 161 (87%) patients, with 95 (59%) sites histologically confirmed. Factors associated with the detection of recurrence included the difference between PSA nadir and PSA at CholPET (odds ratio: 1.30, p < 0.01) and National Comprehensive Cancer Network high-risk classification (odds ratio: 10.83, p = 0.03). One hundred (54.3%) patients recurred in the pelvic soft tissue only, while 61 (33%) had extrapelvic recurrence. Of 21 patients who underwent CholPET prior to meeting the Phoenix criteria of biochemical failure, 15 (71%) had recurrence identified on CholPET with 11 localized to the pelvis. On multivariable analysis, PSA at CholPET, time from RT, and National Comprehensive Cancer Network risk group were predictive of recurrence outside of the pelvis, and a nomogram was generated with a c-index of 0.79. Conclusions CholPET identified the site of recurrence in 87% of patients with a rising PSA after RT; most commonly within the pelvis in potentially salvageable locations. A predictive nomogram was generated, and pending external validation, this may aid in assessing the risk of disease beyond the pelvis. These findings underscore the importance of advanced imaging when considering management strategies for patients with a rising PSA following primary RT. Patient summary We identified anatomic patterns of recurrence in patients with a rising prostate-specific antigen after radiotherapy using C-11 choline positron emission tomography/computed tomography. Most recurrences were localized to the pelvis and we were able to generate a tool to aid in disease localization prior to evaluation with advanced imaging.

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Section: Discussionmentioning

confidence: 95%

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

et al. 2017

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“…Use of salvage lymphadenectomy was examined as part of a systematic review [5]. This demonstrated 50 % of patients remained disease-free after short-term followup [5].…”

mentioning

confidence: 99%

“…This demonstrated 50 % of patients remained disease-free after short-term followup [5]. A question was raised as to combining radiotherapy with salvage lymph node dissection.…”

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confidence: 99%

“…A question was raised as to combining radiotherapy with salvage lymph node dissection. Either way toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high-grade complications [5]. This review concluded level 4 evidence is missing to draw strong clinical points, but in well-selected patients, salvage treatment directed to nodal recurrence could lead to good oncologic outcomes [5].…”

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confidence: 99%

“…Clearly, there is toxicity associated, especially if salvage surgery [5]. This may not be something patients wish to experience after undergoing primary therapy.…”

mentioning

confidence: 99%

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Is there a role for salvage lymphadenectomy as second-line therapy post-robotic radical prostatectomy?

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Guidelines for radiotherapy of prostate cancer (2020 edition)

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In recent years, the incidence of prostate cancer in China has shown a trend of continuous growth. Prostate cancer has become a urinary malignant tumor that seriously affects the health of men in China. Radical surgery and precision radiotherapy are the main methods of radical treatment for prostate cancer. Standardized diagnosis and treatment via a multidisciplinary team should be the standard practice to improve cure rate. Rapid development in imaging, pathology and molecular gene diagnosis has significantly changed the management of prostate cancer. In radiation oncology, image‐guided intensity modulated radiotherapy has been widely adopted in the treatment of prostate cancer. The comprehensive approach centered with radiotherapy has achieved excellent curative effect while continuously reducing treatment‐related side effects.

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Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the Literature

Cited by 83 publications

References 29 publications

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

Identification of Site-specific Recurrence Following Primary Radiation Therapy for Prostate Cancer Using C-11 Choline Positron Emission Tomography/Computed Tomography: A Nomogram for Predicting Extrapelvic Disease

Is there a role for salvage lymphadenectomy as second-line therapy post-robotic radical prostatectomy?

Guidelines for radiotherapy of prostate cancer (2020 edition)

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