Abstract
Purpose We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. Materials and Methods We systematically reviewed the literature in January 2015 using the PubMed®, Web of Sciences and Embase® databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. Results All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. Conclusions Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
| Original language | English |
|---|---|
| Pages (from-to) | 983-988 |
| Number of pages | 6 |
| Journal | Journal of Urology |
| Volume | 194 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 1 2015 |
Fingerprint
Keywords
- local
- lymph node dissection
- neoplasm recurrence
- prostatic neoplasms
- radiotherapy
- salvage therapy
ASJC Scopus subject areas
- Urology
- Medicine(all)
Cite this
Management of node only recurrence after primary local treatment for prostate cancer : A systematic review of the literature. / Ploussard, Guillaume; Almeras, Christophe; Briganti, Alberto; Giannarini, Gianluca; Hennequin, Christophe; Ost, Piet; Renard-Penna, Raphaële; Salin, Ambroise; Lebret, Thierry; Villers, Arnauld; Soulié, Michel; De La Taille, Alexandre; Flamand, Vincent.
In: Journal of Urology, Vol. 194, No. 4, 01.10.2015, p. 983-988.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Management of node only recurrence after primary local treatment for prostate cancer
T2 - A systematic review of the literature
AU - Ploussard, Guillaume
AU - Almeras, Christophe
AU - Briganti, Alberto
AU - Giannarini, Gianluca
AU - Hennequin, Christophe
AU - Ost, Piet
AU - Renard-Penna, Raphaële
AU - Salin, Ambroise
AU - Lebret, Thierry
AU - Villers, Arnauld
AU - Soulié, Michel
AU - De La Taille, Alexandre
AU - Flamand, Vincent
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Purpose We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. Materials and Methods We systematically reviewed the literature in January 2015 using the PubMed®, Web of Sciences and Embase® databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. Results All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. Conclusions Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
AB - Purpose We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. Materials and Methods We systematically reviewed the literature in January 2015 using the PubMed®, Web of Sciences and Embase® databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. Results All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. Conclusions Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
KW - local
KW - lymph node dissection
KW - neoplasm recurrence
KW - prostatic neoplasms
KW - radiotherapy
KW - salvage therapy
UR - http://www.scopus.com/inward/record.url?scp=84941599697&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84941599697&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2015.04.103
DO - 10.1016/j.juro.2015.04.103
M3 - Article
VL - 194
SP - 983
EP - 988
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 4
ER -