PURPOSE: To analyze all available studies assessing the management of node only recurrence after primary local treatment for prostate cancer (PCa).
METHODS: We performed a systematic review of the literature in January 2015 using the PubMed, Web of Sciences and Embase Databases according to PRISMA guidelines. Studies exclusively reporting on visceral or bone metastatic disease were excluded. Eight radiotherapy (RT) and 12 salvage lymph node dissection (sLND) series were included in our qualitative synthesis.
RESULTS: All RT (n=248) and sLND (n=480) studies were single-arm case series including 728 patients. Choline PET/CT is the reference imaging technique for nodal recurrence detection. Globally, 50% of patients remained disease-free after a short-term follow-up. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy leading an over-estimation of PSA-free survival rates obtained after salvage treatment. Combination of RT to sLND may improve oncologic control in treated region without improving outfield relapse risk or PSA response. The great heterogeneity between series in terms of adjuvant treatment, endpoints, progression definition, or study population make it difficult to assess the precise impact of salvage treatment on PSA response, and to compare outcomes between RT and sLND series. Toxicity after RT or sLND was acceptable without frequent high-grade complications. The benefit of early hormone therapy as only salvage treatment remains unknown.
CONCLUSIONS: Although high level of evidence is currently missing to draw any strong conclusion, published clinical series showed that, in selected 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 approach could delay the time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
Ploussard G, Almeras C, Briganti A, Giannarini G, Hennequin C, Ost P, Renard-Penna R, Salin A, Lebret T, Villers A, Soulié M, Taille A, Flamand V. Are you the author?
Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France; INSERM U955, Team 7, Paris Est University, Créteil, France; Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, University of Udine, Italy; Department of Radiation Oncololy, Saint Louis Hospital, Paris 7 University, Paris, France; Department of Radiation Oncololy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Pitié Salpétrière Hospital, Paris 6 University, Paris, France; Department of Urology, Foch Hospital, Université Versailles St Quentin en Yvelines, Suresnes, France; Department of Urology, Lille University Medical Center, Lille University France; Department of Urology, Rangueil Hospital, University of Toulouse, Toulouse, France; INSERM U955, Team 7, Paris Est University, Créteil, France; Department of Urology, Mondor Hospital, Paris Est University, Créteil, France.
Reference: J Urol. 2015 May 8. pii: S0022-5347(15)03911-7.