Stereotactic body radiation therapy after radical prostatectomy: current status and future directions.

Around 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy (RP). The aim of this review is to describe both toxicity and oncological outcomes following stereotactic body radiation therapy (SBRT) delivered to the prostate bed (PB).

In april 2023, we performed a systematic review of studies published in MEDLINE or according to Preferred Reporting Items for Systematic Reviews, using the keywords "stereotactic radiotherapy" AND "postoperative" AND "prostate cancer".

A total of 14 studies assessing either adjuvant or salvage SBRT to the whole PB or macroscopic local recurrence (MLR) within the PB, and SBRT on radiorecurrent MLR within the PB were included. Doses delivered to either whole PB or MLR between 30 to 40 Gy are associated with a low rate of late grade ≥ 2 genitourinary (GU) toxicity, ranging from 2.2 to 15.1%. Doses above 40 Gy are associated with increased rate of late GU toxicity, raising up to 38%. Oncological outcomes should be interpreted with caution, due to both short follow-up, heterogeneous populations and androgen deprivation therapy (ADT) use.

PB or MLR SBRT delivered at doses up to 40 Gy appears safe with relatively low late severe GU toxicity rates. Caution is needed with dose-escalated RT schedules above 40 Gy. Further prospective trials are eagerly awaited in this disease setting.

World journal of urology. 2023 Sep 19 [Epub ahead of print]

Jennifer Le Guevelou, Nicolas Magne, Felipe Counago, Juan Martin Magsanoc, Matthieu Vermeille, Renaud De Crevoisier, Nicolas Benziane-Ouaritini, Piet Ost, Tamim Niazi, Stéphane Supiot, Paul Sargos

Radiation Oncology Department, Centre Eugène-Marquis, Rennes, France., Department of Radiotherapy, Institut Bergonié, Bordeaux, France., Radiation Oncology Department, GenesisCare Madrid Clinical Director, San Francisco de Asis and La Milagrosa Hospitals, National Chair of Research and Clinical Trials, GenesisCare, Madrid, Spain., Radiation Oncology Department, St Lukes Hospital, Quezon City, Philippines., Radiation Oncology Department, Genolier Swiss Radio-Oncology Network, Genolier, Switzerland., Radiation Oncology Department, Iridium Network, Antwerp, Belgium., Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada., Radiation Oncology Department, Institut de Cancérologie de L'Ouest, Nantes, France., Department of Radiotherapy, Institut Bergonié, Bordeaux, France. .