Cancer Control and Complications of Salvage Local Therapy After Failure of Radiotherapy for Prostate Cancer: A Systematic Review
Section snippets
Search Strategy
We reviewed PubMed citations between January 1, 1990 and September 1, 2011. We combined the search terms “salvage and recurrent” and “prostate and high intensity focused ultrasound” or “prostate and cryotherapy,” or “prostatectomy and radiation,” or “prostate and brachytherapy” for 4 separate searches. We also searched the citations in 4 recent prior reviews on salvage treatments6, 7, 8, 9 to ensure a comprehensive search of relevant series. We included only original studies published in
Oncologic Outcomes of Salvage Brachytherapy
The literature synthesis for salvage brachytherapy is listed in Table 1. Most salvage brachytherapy reported in the literature has been performed with low-dose rate (LDR) permanent seed implants. The largest published series remains that from Grado et al published in 1999 and includes 49 patients with a median follow-up of 64 months and a 5-year-FFS rate of 34% using 2 rises above the nadir as the definition of failure.16 However, the FFS rate observed from Grado is somewhat lower than what has
Oncologic Outcomes of Salvage Radical Prostatectomy
The literature synthesis for salvage prostatectomy is listed in Table 2. The largest series published to date comes recently from Chade et al, and included 404 patients treated since 1985 across several institutions, including Memorial Sloan-Kettering Cancer Center, Mayo Clinic, Netherlands Cancer Institute, San Raffaele Hospital, Katholieke Universiteit Leuven, University of Sao Paulo, and Vancouver General Hospital.26 With a median follow-up of 4.4 years, 5-year bDFS was 48%, with failure
Oncologic Outcomes
The literature synthesis for salvage cryotherapy is listed in Table 3. A major challenge in the study of salvage cryotherapy remains the wide variation in definition of PSA control and the lack of a widely accepted definition for biochemical disease progression. The largest series published to date is a multi-institutional study from the COLD registry, including 279 patients from Pisters et al.53 Using the ASTRO definition, 5-year bDFS was 58.9%, with a median follow-up time of 21.6 months. The
Oncologic Outcomes of Salvage HiFU
The literature synthesis for salvage HiFU is in Table 4. Although still a relatively new treatment in the salvage setting, recent studies have helped shed some light on a therapy still considered investigational in the USA. The largest cohort to date comes from Murat et al in France and includes 167 patients with a mean follow-up of 18 months.69 Using a definition for failure as the PSA nadir + 2 (Phoenix definition), the 3-year progression-free survival rate was 53%. Similarly, Uchida et al
Discussion
In this review, we synthesized the literature on the oncologic outcomes and complications of salvage local therapies for recurrent prostate cancer after prior radiation therapy. Although the standard of care for these patients has typically been observation followed by ADT, 2 recent randomized trials of ADT alone vs ADT plus radiation in the definitive setting found that local therapy improves OS for men with locally advanced prostate cancer and provides a rationale to reconsider salvage local
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Cited by (54)
The Case for Brachytherapy: Why It Deserves a Renaissance
2021, Advances in Radiation OncologyCitation Excerpt :A recent phase 2 trial, as well as several retrospective studies, demonstrated excellent rates of cancer-free and biochemical recurrence-free survival with brachytherapy and had acceptable, predominantly grades 1 and 2 gastrointestinal and genitourinary toxicity.51-53 Compared with other local salvage techniques, such as prostatectomy, high-frequency ultrasound, or cryotherapy, prostate brachytherapy has similar rates of biochemical control at 5 years with lower toxicity rates, such as incontinence and bladder neck stricture.54 Prostate brachytherapy remains a viable treatment option for patients, provides excellent outcomes with acceptable toxicity, and is cost effective.
Long-term results of a protocol-based ultrasound-guided salvage brachytherapy as re-irradiation for local recurrent prostate cancer
2020, Radiotherapy and OncologyCitation Excerpt :Comparing our results to the best salvage-prostatectomy series with a rate of rectal injury of 3.6% [19,30], in our analysis we only observed rectal injury in a single patient (1/82, 1.2%). In terms of urinary incontinence rates, the majority of analyses looking at salvage prostatectomy report rates between 18 and 58% [4,23,29,30–32]. This incidence is considerably higher than our reported results – we observed urinary incontinence only in 15/82 patients (18.3%).
Focal Salvage MR Imaging–Guided Cryoablation for Localized Prostate Cancer Recurrence after Radiotherapy: 12-Month Follow-up
2020, Journal of Vascular and Interventional RadiologyCitation Excerpt :This is in contrast to the results after SRP. A systematic review averaging the results of 24 studies reported incontinence in 50%, bladder neck stricture in 26%, rectal injury in 5%, and rectal fistula in 2.4% of patients after SRP (29). This study reported an incontinence rate of 3.2%, 1 urethral stricture (1.6%) needing surgical intervention, no rectal injury, and 3 rectal fistulas (4.8%), which were conservatively treated and resolved or diminished within a few months.
Dr. Nguyen has consulted for Ferring, Inc. The other authors declare no conflict of interest.