Oligorecurrent prostate cancer limited to lymph nodes: getting our ducks in a row: Nodal oligorecurrent prostate cancer

Andrei Fodor, Andrea Lancia, Francesco Ceci, Maria Picchio, Morten Hoyer, Barbara Alicja Jereczek-Fossa, Piet Ost, Paolo Castellucci, Elena Incerti, Nadia Di Muzio, Gianluca Ingrosso

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)2607-2613
Number of pages7
JournalWorld Journal of Urology
Volume37
Issue number12
DOIs
Publication statusPublished - Dec 1 2019

Keywords

  • Choline
  • Oligorecurrent
  • Prostate cancer
  • PSMA
  • Radiotherapy
  • SBRT

ASJC Scopus subject areas

  • Urology

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