First-line Systemic Treatment of Recurrent Prostate Cancer After Primary or Salvage Local Therapy: A Systematic Review of the Literature.

Several studies have investigated selection and sequencing of systemic agents to manage recurrent prostate cancer following local definitive treatment.

To define the incidence of recurrent prostate cancer in different countries, and systematically review management options and efficacy of first-line systemic therapies for patients with prostate cancer previously treated with definitive radical prostatectomy or radiation therapy.

We performed a systematic review of studies published from January 2010 to December 2021 in MEDLINE, EMBASE, or according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Quality was assessed using the Grades of Recommendation, Assessment, Development and Evaluation methodology. The potential regional burdens of recurrent prostate cancer were estimated by analyzing various regional registry data.

A total of 40 studies met the inclusion criteria and an additional landmark study published after the query was included in this review. Patients with metastatic recurrent disease derive benefit from the addition of androgen receptor signaling inhibitors to androgen deprivation therapy, while docetaxel should be reserved for patients with a high-volume metastatic burden by conventional imaging. Patients with biochemical-only recurrent disease benefit from continuous or intermittent androgen deprivation therapy if they possess high-risk features such as short prostate-specific antigen doubling time or high serum prostate-specific antigen. Current limitations to the published literature include no consideration of contemporary positron emission tomography imaging for evaluating metastatic recurrence or burden and few quality of life assessments.

This systematic review summarizes the findings and recommendations for first-line systemic therapy for patients with recurrent prostate cancer following local therapy.

We performed a systematic evaluation and summary of all studies published within the past decade on the topic of medications used to treat prostate cancer after it has recurred following radiation therapy or surgery. This review can be used to inform guidelines for prostate cancer management.

European urology oncology. 2022 May 28 [Epub ahead of print]

Adam B Weiner, Aisha L Siebert, Sarah E Fenton, Wassim Abida, Neeraj Agarwal, Ian D Davis, Tanya B Dorff, Martin Gleave, Nicholas D James, Darren M C Poon, Hiroyoshi Suzuki, Christopher J Sweeney

Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Australia Eastern Health, Melbourne, Victoria, Australia., Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA., Vancouver Prostate Centre, Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada., Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK., Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong., Department of Urology, Toho University Sakura Medical Center, Chiba, Japan., Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: .