Salvage therapy for prostate cancer after radical prostatectomy

TY - JOUR

T1 - Salvage therapy for prostate cancer after radical prostatectomy

AU - Zaorsky, Nicholas G

AU - Calais, Jeremie

AU - Fanti, Stefano

AU - Tilki, Derya

AU - Dorff, Tanya

AU - Spratt, Daniel E

AU - Kishan, Amar U

N1 - © 2021. Springer Nature Limited.

PY - 2021/11

Y1 - 2021/11

N2 - More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.

AB - More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.

U2 - 10.1038/s41585-021-00497-7

DO - 10.1038/s41585-021-00497-7

M3 - SCORING: Review article

C2 - 34363040

VL - 18

SP - 643

EP - 668

JO - NAT REV UROL

JF - NAT REV UROL

SN - 1759-4812

IS - 11

ER -