Biochemical failure after primary external beam radiotherapy for prostate cancer is common, and a significant proportion of these failures are due to local residual or recurrent disease. Early or delayed palliation using androgen deprivation therapy is the most common approach. Although a conservative approach is appropriate for many individuals, selected patients would benefit from retreatment with curative intent. We review the pertinent literature on salvage of locally recurrent prostate cancer after primary radiotherapy, including the modalities of surgery, cryotherapy, high-intensity focused ultrasound, or reirradiation with brachytherapy or stereotactic body radiotherapy. We discuss patient selection, outcomes, and toxicities. Patients with local recurrence and sufficient life expectancy, in the absence of metastatic disease, could be considered for local salvage. Although highly dependent on patient selection, the efficacy of the various salvage options seems comparable, with biochemical-recurrence-free survivals ranging approximately 50% at 5 years. The toxicity profiles differ, but all salvage treatments are more toxic than primary treatment. Management of isolated local failure after radiotherapy remains challenging. However, with the recent progress in salvage techniques, and more sensitive functional imaging for tumor localization and staging, salvage treatments are likely to play an increasingly important role.
Abstract Purpose Only retrospective data is available for low dose rate (LDR) salvage prostate brachytherapy for local recurrence after external beam radiotherapy (EBRT). The primary objective of this prospective Phase II trial (NCT00450411) was to evaluate late gastrointestinal and genitourinary adverse events (AEs) after salvage LDR brachytherapy. Materials/Methods Eligible patients had low/intermediate risk prostate cancer prior to EBRT and biopsy-proven recurrence >30 months after EBRT, with...
Purpose Organ-confined prostate cancer recurrences after primary radiotherapy can be treated with salvage iodine-125 brachytherapy. Options include total salvage (TS) or focal salvage (FS). TS often leads to severe late gastrointestinal (GI) toxicity. Differences in rectal dosimetry between TS and FS are presented and dose constraints proposed to reduce late severe GI toxicity (>90 days). Methods and Materials Intraoperative dosimetry and 30-day CT-dosimetry of 20 FS and 28 TS patients were eval...
Objective To analyse oncological and functional outcomes of salvage radical prostatectomy (SRP) in patients with recurrent prostate cancer and to compare outcomes of patients within and outside the European Association of Urology (EAU) guideline criteria (organ-confined prostate cancer ≤T2b, Gleason score ≤7 and preoperative PSA level <10 ng/mL) for SRP. Patients and Methods In all, 55 patients who underwent SRP from January 2007 to December 2012 were retrospectively analysed. Kaplan–Meier curve...
Abstract Background and purpose Patients treated with low radiotherapy dose or treated at young age are at a risk of developing local relapse. Although data are preliminary, brachytherapy seems an attractive treatment option for recurrent prostate cancer after previous radiotherapy. Therefore, the UroGEC group of the GEC-ESTRO conducted a Delphi study, to explore expert opinion on the management of salvage prostate brachytherapy. Material and methods For this study, a series of digital questionn...
Abstract Purpose Patients with locally recurrent adenocarcinoma of the prostate following radiation therapy (RT) present a challenging problem. We prospectively evaluated the use of "high-dose-rate-like" prostate stereotactic body RT (SBRT) salvage for this circumstance, evaluating prostate-specific antigen response, disease-free survival, and toxicity. Methods and materials Between February 2009 and March 2014, 29 patients with biopsy-proven recurrent locally prostate cancer >2 years post-RT we...
Abstract Introduction Salvage Iodine-125 brachytherapy (I-125-BT) constitutes a curative treatment approach for patients with organ-confined recurrent prostate cancer after primary radiotherapy. Currently, focal salvage (FS) instead of whole-gland or total salvage (TS) is being investigated, to reduce severe toxicity associated with cumulative radiation dose. Differences in urethral and bladder dosimetry and constraints to reduce late (>90days) genitourinary (GU) toxicity are presented here. Mat...
Last. Vipul R. Patel(UCF: University of Central Florida)H-Index: 21
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Abstract Background To report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (s-RARP) in a propensity score-matched analysis. Study design 53 patients underwent s-RARP at our institution. Perioperative, functional and oncological outcomes were compared between propensity matched cohorts. Results Patients in the s-RARP group were at significantly higher risk based on the D'Amico classification system ( p = 0.010). Estimated blood loss, ...
#2Taimur T. Shah(UCL: University College London)H-Index: 14
Last. Hashim U. Ahmed(UCL: University College London)H-Index: 62
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Abstract Background One-third of men may experience biochemical failure by 8 years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and charac...
#2June M. Chan(UCSF: University of California, San Francisco)H-Index: 64
Last. Miguel A. Hernán(MIT: Massachusetts Institute of Technology)H-Index: 107
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Background: The optimal timing to start androgen deprivation therapy (ADT) in prostate cancer patients with rising prostate-specific antigen (PSA) as the only sign of relapse is unknown. Methods: We identified men with prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavour (CaPSURE) study who would have been eligible (6 cT3aN0M0, primary radical prostatectomy or radiotherapy, PSA relapse as the only evidence of recurrence) for a randomised trial comparing 'immediate'...
#1Matthias Eiber(TUM: Technische Universität München)H-Index: 55
#1Matthias Eiber(TUM: Technische Universität München)H-Index: 5
Last. Markus Schwaiger(TUM: Technische Universität München)H-Index: 148
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The expression of prostate-specific membrane antigen (PSMA) is increased in prostate cancer. Recently, (68)Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga(HBED-CC)]) was developed as a PSMA ligand. The aim of this study was to investigate the detection rate of (68)Ga-PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy.Two hundred forty-eight of 393 patients were evaluable for a retrospective analysis. Median prostate-specific antigen (PSA) level was 1.99 ng/mL (range, 0.2-59....
Last. Jan J W Lagendijk(University Medical Center Utrecht)H-Index: 14
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Purpose - The Utrecht single needle implant device was redesigned to increase needle insertion velocity. The purpose of this study is to evaluate the Magnetic Resonance compatibility, safety and accuracy of the implant device preparing its application in a patient study to investigate the feasibility of inserting a brachytherapy needle into the prostate to a defined tumour target point. Methods - Several experiments were performed to evaluate the mechanical and radiofrequency safety of the needl...
Abstract Background and purpose Between 30% and 47% of patients treated with definitive radiotherapy (RT) for prostate cancer are at risk of intraprostatic recurrence during follow-up. Re-irradiation with stereotactic body RT (SBRT) is emerging as a feasible and safe therapeutic option. However, no consensus or guidelines exist on this topic. The purpose of this ESTRO ACROP project is to investigate expert opinion on salvage SBRT for intraprostatic relapse after RT. Materials and Methods A 40-it...
Abstract Aims The best therapeutic approach for local relapses of previously irradiated prostate cancer (PC) is still not defined. Re-irradiation (Re-I) could offer a chance of cure for highly selected patients, although high quality evidences are lacking. The aim of our study is to provide a literature review on efficacy and safety of Re-I. Methods Only studies where Re-I field overlaps with previous radiotherapy were considered. To determine 2 and 4 years overall mortality (OM), 2 and 4 years ...
Background Gaining insight into microRNAs (miRNAs) and genes that regulate the therapeutic response of cancer diseases in general and prostate cancer (PCa) in particular is an important issue in current molecular biomedicine and allows the discovery of predictive miRNA targets. Objectives The aim of this study was to analyze the available data on the influence of radiotherapy (RT) on miRNA expression and on miRNA involved in radiotherapy response in PCa. Materials and methods The data used in th...
BACKGROUND Advances in imaging, biomaterials and precision radiotherapy provide new opportunities to salvage locally recurrent prostate cancer (PC). This study evaluates the efficacy and safety of re-irradiation using stereotactic body radiation therapy (SBRT). We hypothesized that patients with castrate-resistant PC (CRPC) would benefit less from local salvage. METHODS A prospective clinical database was reviewed to extract 30 consecutive patients treated with prostate re-irradiation. Gallium p...
Radical prostatectomy and external beam radiotherapy are recognized as comparable treatment options for localized prostate cancer. Previous studies of oncological outcomes of surgery versus radiotherapy have reported their comparability or possible superiority of surgery. However, the issue of which treatment is better remains controversial. Several factors make fair comparison of their outcomes difficult: different patient backgrounds caused by selection bias, different definitions of biochemic...
Last. Fadil Akyol(Hacettepe University)H-Index: 18
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Abstract Purpose The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy. Materials and methods Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiolog...
Speckle-type POZ (pox virus and zinc finger protein) protein (SPOP) is the most commonly mutated gene in prostate cancer (PCa). Recent evidence reports a role of SPOP in DNA damage response (DDR), indicating a possible impact of SPOP deregulation on PCa radiosensitivity. This study aimed to define the role of SPOP deregulation (by gene mutation or knockdown) as a radiosensitizing factor in PCa preclinical models. To express WT or mutant (Y87N, K129E and F133V) SPOP, DU145 and PC-3 cells were tra...
This article reviews the most current methods and technological aspects of high-intensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam ...
Background Optimal management of isolated local recurrence of prostate cancer after primary radiotherapy remains to be defined. Up-front androgen deprivation therapy (ADT) is widely used but may adversely affect the quality of life and is essentially a palliative treatment. Local salvage carries a different side-effect profile and is potentially curative, but it has not been compared to ADT. Materials and methods We conducted a propensity-matched analysis of cohorts of men treated with either wh...