Loco-regional treatment for castration-resistant prostate cancer: Is there any rationale? A critical review from the AFU-GETUG

Beauval, Jean-Baptiste; Loriot, Yohann; Hennequin, Christophe; Rozet, François; Barthélémy, Philippe; Borchiellini, Delphine; Constans, Friederike Schlürmann; Groß, E.; Maillet, Denis; Pasticier, G.; Pignot, G.; Timsit, Marc‐Olivier; Vincendeau, S.; Ploussard, Guillaume; Sargos, P.

doi:10.1016/j.critrevonc.2017.12.012

Cited by 13 publications

(6 citation statements)

References 46 publications

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“…The results in terms of survival without second-generation hormone therapy are similar to those of Charlien et al [6]. The role of radiotherapy on oligoprogressive lesions in oligoprogressive prostate cancer has yet to be defined because the studies conducted to date are insufficient [18].…”

Section: Discussionsupporting

confidence: 75%

Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Ka¹,

Gaye²,

Badiane³

et al. 2021

JCT

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Background: The therapeutic standard for oligoprogressive prostate cancer resistant to castration is second-generation hormone therapy. This systemic treatment is expensive. There are oligoprogressive lesions accessible to radiotherapy. Objectives: To study the impact of radiotherapy of oligoprogressive lesions on the implementation of second generation hormone therapy. Patients and Methods: A retrospective study from 2012 to 2020 was carried out. All patients with oligoprogressive prostate cancer who had received radiotherapy on one or more lesions in progression were collated. Survival was calculated using the Kaplan-Meier method. Results: 8 patients were treated with stereotactic and conformational radiotherapy between August 2012 and August 2020 in the context of oligoprogressive prostate cancer resistant to castration. The median age at diagnosis of oligoprogression was 73 years with a median PSA level of 3.11 ng/ml. Nine lesions were diagnosed with PET scan PSMA. All the lesions were treated by radiotherapy with different regimens. After a median follow-up of 12.5 months, 7 patients showed a biochemical response to treatment with a median decrease in PSA of 67%. The median survival without clinical or biochemical progression was 7 months. The median survival without the need for further systemic treatment was 9 months. During the follow-up period, six patients received second-generation hormone therapy to treat their relapse, and the other two showed no clinical or biochemical relapse. Conclusion: Radiotherapy may be an alternative to delay the introduction of difficult-to-access second-generation hormone thera-How to cite this paper:

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Section: Discussionsupporting

confidence: 75%

Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Ka¹,

Gaye²,

Badiane³

et al. 2021

JCT

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show abstract

“…Finally, MDT could also be debated for castration-resistant PCa, even if our population was limited in this regard ( 43 ). For example, in a prospective study of 29 patients (of which 37.9% were castration-resistant) with oligo-metastatic PCa, SBRT allowed controlled PSA levels in 20 patients (with a median follow-up of 11.5 months), thus avoiding the use of systemic therapy and delayed its use by a median of 39.7 months in the remaining nine patients ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

Single-Center Experience of Focal Thermo-Ablative Therapy After Pelvic Radiotherapy for In-Field Prostate Cancer Oligo-Recurrence

et al. 2021

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PurposeIn-field prostate cancer (PCa) oligo-recurrence after pelvic radiotherapy is a challenging situation for which metastasis-directed treatments may be beneficial, but options for focal therapies are scarce.MethodsWe retrospectively reviewed data for patients with three or less in-field oligo-recurrent nodal, bone and/or locally recurrent (prostate, seminal vesicles, or prostatic bed) PCa lesions after radiation therapy, identified with molecular imaging (PET and/or MRI) and treated by focal ablative therapy (cryotherapy or radiofrequency) at the Institut Bergonié between 2012 and 2020. Chosen endpoints were the post-procedure PSA response (partially defined as a >50% reduction, complete as a PSA <0.05 ng/ml), progression-free survival (PFS) defined as either a biochemical relapse (defined as a rise >25% of the Nadir and above 2 ng/ml), radiological relapse (on any imaging technique), decision of treatment modification (hormonotherapy initiation or line change) or death, and tolerance.ResultsForty-three patients were included. Diagnostic imaging was mostly 18F-Choline positron emission tomography/computerized tomography (PET/CT) (75.0%), prostate specific membrane antigen (PSMA) PET/CT (9.1%) or a combination of pelvic magnetic resonance imaging (MRI), CT, and 99 mTc-bone scintigraphy (11.4%). PSA response was observed in 41.9% patients (partial in 30.3%, complete in 11.6%). In the hormone-sensitive exclusive focal ablation group (n = 31), partial and complete PSA responses were 32.3 and 12.9% respectively. Early local control (absence of visible residual active target) on the post-procedure imaging was achieved with 87.5% success. After a median follow-up of 30 months (IQR 13.3–56.8), the median PFS was 9 months overall (95% CI, 6–17), and 17 months (95% CI, 11–NA) for PSA responders. Complications occurred in 11.4% patients, with only one grade IIIb Dindo–Clavien event (uretral stenosis requiring endoscopic uretrotomy).ConclusionIn PCa patients showing in-field oligo-recurrence after pelvic radiotherapy, focal ablative treatment is a feasible option, possibly delaying a systemic treatment initiation or modification. These invasive strategies should preferably be performed in expert centers and discussed along other available focal strategies in multi-disciplinary meetings.

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“…All three agents have shown benefit in prolonging metastasis-free survival in patients with nonmetastatic CRPC (nmCRPC), with tolerable toxicity [103][104][105]. Radiation therapy to the primary tumour is, for some authors, questionable [106], but no prospective data have yet been reported. If PSMA PET is positive, the number of metastatic lesions has important implications for treatment decision-making.…”

Section: B2b: Prostate Cancer Summarymentioning

confidence: 99%

B2B: Prostate Cancer

Loeb¹,

Black²,

Wyatt³

et al. 2021

Société Internationale D’Urologie Journal

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Loco-regional treatment for castration-resistant prostate cancer: Is there any rationale? A critical review from the AFU-GETUG

Cited by 13 publications

References 46 publications

Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Single-Center Experience of Focal Thermo-Ablative Therapy After Pelvic Radiotherapy for In-Field Prostate Cancer Oligo-Recurrence

B2B: Prostate Cancer

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