Radiation Therapy After Radical Prostatectomy

TY - JOUR

T1 - Radiation Therapy After Radical Prostatectomy

T2 - What Has Changed Over Time?

AU - Zattoni, Fabio

AU - Heidegger, Isabel

AU - Kasivisvanathan, Veeru

AU - Kretschmer, Alexander

AU - Marra, Giancarlo

AU - Magli, Alessandro

AU - Preisser, Felix

AU - Tilki, Derya

AU - Tsaur, Igor

AU - Valerio, Massimo

AU - van den Bergh, Roderick

AU - Kesch, Claudia

AU - Ceci, Francesco

AU - Fankhauser, Christian

AU - Gandaglia, Giorgio

N1 - Copyright © 2021 Zattoni, Heidegger, Kasivisvanathan, Kretschmer, Marra, Magli, Preisser, Tilki, Tsaur, Valerio, van den Bergh, Kesch, Ceci, Fankhauser and Gandaglia.

PY - 2021

Y1 - 2021

N2 - The role and timing of radiotherapy (RT) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) remains controversial. While recent trials support the oncological safety of early salvage RT (SRT) compared to adjuvant RT (ART) in selected patients, previous randomized studies demonstrated that ART might improve recurrence-free survival in patients at high risk for local recurrence based on adverse pathology. Although ART might improve survival, this approach is characterized by a risk of overtreatment in up to 40% of cases. SRT is defined as the administration of RT to the prostatic bed and to the surrounding tissues in the patient with PSA recurrence after surgery but no evidence of distant metastatic disease. The delivery of salvage therapies exclusively in men who experience biochemical recurrence (BCR) has the potential advantage of reducing the risk of side effects without theoretically compromising outcomes. However, how to select patients at risk of progression who are more likely to benefit from a more aggressive treatment after RP, the exact timing of RT after RP, and the use of hormone therapy and its duration at the time of RT are still open issues. Moreover, what the role of novel imaging techniques and genomic classifiers are in identifying the most optimal post-operative management of PCa patients treated with RP is yet to be clarified. This narrative review summarizes most relevant published data to guide a multidisciplinary team in selecting appropriate candidates for post-prostatectomy radiation therapy.

AB - The role and timing of radiotherapy (RT) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) remains controversial. While recent trials support the oncological safety of early salvage RT (SRT) compared to adjuvant RT (ART) in selected patients, previous randomized studies demonstrated that ART might improve recurrence-free survival in patients at high risk for local recurrence based on adverse pathology. Although ART might improve survival, this approach is characterized by a risk of overtreatment in up to 40% of cases. SRT is defined as the administration of RT to the prostatic bed and to the surrounding tissues in the patient with PSA recurrence after surgery but no evidence of distant metastatic disease. The delivery of salvage therapies exclusively in men who experience biochemical recurrence (BCR) has the potential advantage of reducing the risk of side effects without theoretically compromising outcomes. However, how to select patients at risk of progression who are more likely to benefit from a more aggressive treatment after RP, the exact timing of RT after RP, and the use of hormone therapy and its duration at the time of RT are still open issues. Moreover, what the role of novel imaging techniques and genomic classifiers are in identifying the most optimal post-operative management of PCa patients treated with RP is yet to be clarified. This narrative review summarizes most relevant published data to guide a multidisciplinary team in selecting appropriate candidates for post-prostatectomy radiation therapy.

U2 - 10.3389/fsurg.2021.691473

DO - 10.3389/fsurg.2021.691473

M3 - SCORING: Review article

C2 - 34307443

VL - 8

JO - FRONT SURG

JF - FRONT SURG

SN - 2296-875X

M1 - 691473

ER -