Management of node only recurrence after primary local treatment for prostate cancer

A systematic review of the literature

Guillaume Ploussard, Christophe Almeras, Alberto Briganti, Gianluca Giannarini, Christophe Hennequin, Piet Ost, Raphaële Renard-Penna, Ambroise Salin, Thierry Lebret, Arnauld Villers, Michel Soulié, Alexandre De La Taille, Vincent Flamand

Research output: Contribution to journalArticle

50 Citations (Scopus)

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 languageEnglish
Pages (from-to)983-988
Number of pages6
JournalJournal of Urology
Volume194
Issue number4
DOIs
Publication statusPublished - Oct 1 2015

Fingerprint

Salvage Therapy
Lymph Node Excision
Prostatic Neoplasms
Radiotherapy
Recurrence
Prostate-Specific Antigen
Hormones
Therapeutics
Bone Diseases
Secondary Prevention
Choline
PubMed
Positron-Emission Tomography
Androgens
Survival Rate
Tomography
Databases
Guidelines
Safety
Population

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 journalArticle

Ploussard, G, Almeras, C, Briganti, A, Giannarini, G, Hennequin, C, Ost, P, Renard-Penna, R, Salin, A, Lebret, T, Villers, A, Soulié, M, De La Taille, A & Flamand, V 2015, 'Management of node only recurrence after primary local treatment for prostate cancer: A systematic review of the literature', Journal of Urology, vol. 194, no. 4, pp. 983-988. https://doi.org/10.1016/j.juro.2015.04.103
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. / Management of node only recurrence after primary local treatment for prostate cancer : A systematic review of the literature. In: Journal of Urology. 2015 ; Vol. 194, No. 4. pp. 983-988.
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AU - Renard-Penna, Raphaële

AU - Salin, Ambroise

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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.

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