Sequential treatment for recurrent localized prostate cancer

Poel, Henk G. van der; Moonen, L.; Horenblas, Simon

doi:10.1002/jso.20967

Cited by 19 publications

(20 citation statements)

References 32 publications

(34 reference statements)

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“…It was shown that 10‐year cancer control rates did not differ significantly between patients who underwent radiation therapy followed by salvage RP and those who underwent RP followed by salvage radiation therapy. However, urinary continence and erectile function were better preserved in patients undergoing salvage radiotherapy after surgery than in patients undergoing salvage prostatectomy after radiation [22]. This finding of a better quality of life for those patients treated with surgery followed by adjunctive radiotherapy could also have contributed to a higher acceptance of RP for treating high‐risk patients’ tumours.…”

Section: Discussionmentioning

confidence: 99%

“…Van Der Poel et al . [22] recently reported the effectiveness and morbidity of sequential treatment of patients with recurrent localized PCa. It was shown that 10‐year cancer control rates did not differ significantly between patients who underwent radiation therapy followed by salvage RP and those who underwent RP followed by salvage radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

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Inverse stage migration in patients undergoing radical prostatectomy: results of 8916 European patients treated within the last decade

Budäus¹,

Spethmann²,

Isbarn³

et al. 2011

BJU International

104

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These authors contributed equally to the manuscript• When patients were stratified based on their clinical findings according to the D'Amico risk groups for disease progression, the proportion of low-risk patients dropped from 66% in 2004 to 35% ( P = 0.016) in the final year of the study period.• Similarly, histopathological evaluation of RP specimens showed a decrease of favourable disease (organ confinement and Gleason 3 + 3 grade) from 53 to 17% ( P = 0.008).• This trend was accompanied by an increase in the number of patients with nonorgan-confined prostate cancer (PCa) from 19% in 2003 to 33% in 2009 ( P = 0.008).• The restriction of the analyses in the present study to a single tertiary-care centre could limit the generalizeability of the results. CONCLUSIONS• During the last decade, we observed an inverse stage migration trend in those European patients with PCa who were treated with RP.• The recorded increase in patients with non-organ-confined disease after RP could be related to changes in patient selection and the growing adoption of RP in multimodal treatment settings for locally advanced tumours as well as the availability of new treatment alternatives for low-risk disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inverse stage migration in patients undergoing radical prostatectomy: results of 8916 European patients treated within the last decade

Budäus¹,

Spethmann²,

Isbarn³

et al. 2011

BJU International

104

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“…In principle, toxicity of salvage RT with total doses of about 70 Gy is low with less than 3% of late grade 3 proctitis or genitourinary side effects, respectively. [19, 27, 33, 38]. …”

Section: Resultsmentioning

confidence: 99%

Postoperative Radiotherapy after Radical Prostatectomy: Indications and Open Questions

et al. 2012

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Biochemical relapse after radical prostatectomy occurs in approximately 15–40% of patients within 5 years. Postoperative radiotherapy is the only curative treatment for these patients. After radical prostatectomy, two different strategies can be offered, adjuvant or salvage radiotherapy. Adjuvant radiotherapy is defined as treatment given directly after surgery in the presence of risk factors (R1 resection, pT3) before biochemical relapse occurs. It consists of 60–64 Gy and was shown to increase biochemical relapse-free survival in three randomized controlled trials and to increase overall survival after a median followup of 12.7 years in one of these trials. Salvage radiotherapy, on the other hand, is given upon biochemical relapse and is the preferred option, by many centers as it does not include patients who might be cured by surgery alone. As described in only retrospective studies the dose for salvage radiotherapy ranges from 64 to 72 Gy and is usually dependent on the absence or presence of macroscopic recurrence. Randomized trials are currently investigating the role of adjuvant and salvage radiotherapy. Patients with biochemical relapse after prostatectomy should at the earliest sign of relapse be referred to salvage radiotherapy and should preferably be treated within a clinical trial.

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“…Combined modality treatment utilizing surgery, radiation treatment and systemic therapy is the standard of care in other cancers, such as colon and breast. Furthermore, the safety of RP followed by RT rather than the other way around has been previously emphasized …”

Section: What Are the Pros And Cons Of Radical Prostatectomy In Men Wmentioning

confidence: 99%

“…72 Although the cancer outcomes are good after salvage surgery, it is still true that RT is better tolerated after RP than the other way around in men requiring additional treatment for their aggressive prostate cancer. [74][75][76] What are the pros and cons of radical prostatectomy in men with high-risk prostate cancer?…”

Section: Salvage Prostatectomy After Failure Of Other Primary Therapiesmentioning

confidence: 99%

Radical prostatectomy in high‐risk prostate cancer

Ischia

Gleave

2013

Int J of Urology

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Abbreviations & AcronymsAbstract: One consistent finding in the studies regarding treating men with prostate cancer is that men with high-risk disease have the most to gain from treatment with curative intent. Men with high-risk or locally-advanced prostate cancer require treatment to the primary cancer or risk dying prematurely from their disease. Increasingly, combined androgen deprivation therapy + radiation treatment is seen as the standard treatment as a result of prospective studies in this space, and the perceived increased morbidity of radical prostatectomy in the setting of a "low" cure rate as monotherapy. In the absence of a well-conducted randomized trial, there is no definite evidence that one treatment is superior to the other. The advantages of radical prostatectomy are that it provides excellent local control of the primary tumor without an increase in morbidity, accurately stages the disease to guide further therapy, and removes benign sources of prostate-specific antigen so that failures can be promptly identified and subsequent treatment can be initiated in a timely manner. Although several guidelines recommend radiation treatment over radical prostatectomy as first-line treatment, there is no evidence that surgery is inferior and radical prostatectomy should remain part of any informed discussion regarding treatment options for men with high-risk prostate cancer.

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Sequential treatment for recurrent localized prostate cancer

Cited by 19 publications

References 32 publications

Inverse stage migration in patients undergoing radical prostatectomy: results of 8916 European patients treated within the last decade

Inverse stage migration in patients undergoing radical prostatectomy: results of 8916 European patients treated within the last decade

Postoperative Radiotherapy after Radical Prostatectomy: Indications and Open Questions

Radical prostatectomy in high‐risk prostate cancer

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