TY - JOUR
T1 - Oligorecurrent prostate cancer limited to lymph nodes
T2 - getting our ducks in a row: Nodal oligorecurrent prostate cancer
AU - Fodor, Andrei
AU - Lancia, Andrea
AU - Ceci, Francesco
AU - Picchio, Maria
AU - Hoyer, Morten
AU - Jereczek-Fossa, Barbara Alicja
AU - Ost, Piet
AU - Castellucci, Paolo
AU - Incerti, Elena
AU - Di Muzio, Nadia
AU - Ingrosso, Gianluca
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Purpose: Oligorecurrent prostate cancer with exclusive nodal involvement represents a common state of disease, amenable to local therapy. New radio-labeled tracers have enriched the possibility of cancer detection and treatment. In this review, we aim to illustrate the main nuclear medicine diagnostic options and the role of radiotherapy in this setting of patients. Methods: We performed a PubMed search referring to the PRISMA guidelines to analyze the performance of PSMA- and choline-PET in detecting oligorecurrence limited to lymph nodes, and to review the main studies supporting either ablative stereotactic body radiotherapy or regional lymph node irradiation in this clinical setting. Results: PSMA-PET has shown higher efficacy in the diagnosis of nodal lesions if compared with choline-PET. More specifically, for PSA ≤ 2 ng/ml, the median detection rate of choline-PET ranges from 19.5 to 44.5%, whereas PSMA ranges from 51.5 to 74%. SBRT achieves high local control rates positively affecting progression-free survival (PFS), with androgen deprivation therapy (ADT)-free survival ranging from 25 to 44 months and with low toxicity rates (0–15%). Prophylactic nodal irradiation shows 3-year PFS rates ranging from 62 to 75%, but with a potential higher risk of toxicity. However, the chosen treatment option needs to be tailored on the single patient. Conclusions: Newer PET/CT radio-labeled tracers have increased disease detection in oligorecurrent prostate cancer patients. Growing evidence of their impact on metastasis-directed therapy encourages the use of the most advanced radiotherapy techniques in the clinical management of such patients.
AB - Purpose: Oligorecurrent prostate cancer with exclusive nodal involvement represents a common state of disease, amenable to local therapy. New radio-labeled tracers have enriched the possibility of cancer detection and treatment. In this review, we aim to illustrate the main nuclear medicine diagnostic options and the role of radiotherapy in this setting of patients. Methods: We performed a PubMed search referring to the PRISMA guidelines to analyze the performance of PSMA- and choline-PET in detecting oligorecurrence limited to lymph nodes, and to review the main studies supporting either ablative stereotactic body radiotherapy or regional lymph node irradiation in this clinical setting. Results: PSMA-PET has shown higher efficacy in the diagnosis of nodal lesions if compared with choline-PET. More specifically, for PSA ≤ 2 ng/ml, the median detection rate of choline-PET ranges from 19.5 to 44.5%, whereas PSMA ranges from 51.5 to 74%. SBRT achieves high local control rates positively affecting progression-free survival (PFS), with androgen deprivation therapy (ADT)-free survival ranging from 25 to 44 months and with low toxicity rates (0–15%). Prophylactic nodal irradiation shows 3-year PFS rates ranging from 62 to 75%, but with a potential higher risk of toxicity. However, the chosen treatment option needs to be tailored on the single patient. Conclusions: Newer PET/CT radio-labeled tracers have increased disease detection in oligorecurrent prostate cancer patients. Growing evidence of their impact on metastasis-directed therapy encourages the use of the most advanced radiotherapy techniques in the clinical management of such patients.
KW - Choline
KW - Oligorecurrent
KW - Prostate cancer
KW - PSMA
KW - Radiotherapy
KW - SBRT
UR - http://www.scopus.com/inward/record.url?scp=85046728522&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046728522&partnerID=8YFLogxK
U2 - 10.1007/s00345-018-2322-7
DO - 10.1007/s00345-018-2322-7
M3 - Article
C2 - 29752513
AN - SCOPUS:85046728522
VL - 37
SP - 2607
EP - 2613
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
IS - 12
ER -