Salvage Radiotherapy for Prostate Cancer. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Rans, K.; Berghen, C.; Joniau, S.; De Meerleer, G.
• Is Part Of: Clinical oncology. Volume 32:Issue 3(2020)
• Page Start: 156
• Page End: 162
• Publication Date: 2020-03
• Subjects: Adjuvant radiotherapy -- androgen deprivation therapy -- prostate cancer -- prostate-specific antigen -- PSMA PET-CT -- salvage radiotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2020.01.003
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: For patients experiencing biochemical recurrence in the absence of distant metastasis, salvage radiotherapy (SRT) with or without androgen deprivation therapy (ADT) is currently the only possible curative treatment option. Prostate-specific antigen (PSA) monitoring and the selected use of SRT has some advantages when compared with adjuvant radiotherapy. The most important one is avoidance of a potential overtreatment of patients who would never have disease progression, even in the presence of high-risk pathological features. The identification of a specific PSA cut-off seems to be incorrect. In patients with more adverse pathological features, early SRT administered at the very first sign of a PSA rise granted better disease control. Dose-intensified SRT is feasible and well tolerated with no significant difference in grade 2 or more acute and late toxicity. At least 66 Gy must be given in the salvage setting. ADT has a radio-sensitising effect on the radiotherapy by inhibiting the repair of DNA double-strand breaks. The use of ADT in the salvage setting results in a better oncological outcome. Hormonal therapy is associated with a decrease in quality of life and side-effects depending on the duration of hormone therapy. The oncological benefit of hormone therapy duration depends on their clinical and pathological characteristics. 68-Ga-prostate-specific membrane antigen positron emission tomography-computed tomography is the gold standard in staging prostate cancer patients with biochemical persistence or recurrence after radical prostatectomy. The implementation of 18F-labelled PSMA tracers can provide a further improvement. Highlights: RT is the only curative treatment in case of biochemical recurrence after surgery. Early SRT at the first sign of PSA rise granted better disease control. High-dose radiotherapy is well tolerated in the salvage setting. The duration of optimal ADT treatment depends on the amount of risk factors.