Elif Ozkan E1*, Soyupek S2 and Erdogan M3
1Department of Radiation Oncology, Suleyman Demirel University, Turkey
2Department of Urology, Suleyman Demirel University, Turkey
3Department of Nuclear Medicine, Suleyman Demirel University, Turkey
Even in the current era of dose-escalated radiotherapy for prostate cancer, biochemical recurrence is common. Furthermore, biochemical failure is not specific to the site of recurrence. One of the major challenges in the management of prostate cancer patients with biochemical failure after radiotherapy is the early discrimination between those with locoregional recurrence only and those with metastatic disease. While the latter are generally considered incurable, patients with locoregional disease may benefit from emerging treatment options. Ultimately, the objective of salvage therapy is to control disease while ensuring minimal collateral damage, thereby optimizing both cancer and toxicity outcomes. Advances in functional imaging, including multiparametric prostate MRI, abdominopelvic lymphangio-MRI, sentinel node SPECT-CT and/or whole-body PET/CT have paved the way for salvage radiotherapy in patients with local recurrence, microscopic nodal disease limited to the pelvis or oligometastatic disease. These patients may be considered for salvage reirradiation using different techniques: prostate low-dose or high-dose rate brachytherapy, pelvic and/or lomboaortic image-guided radiotherapy with elective nodal irradiation, focal nodal or bone Stereotactic Body Radiation Therapy (SBRT). An individualized approach is recommended. The decision about which treatment, if any, to use will be based on the initial characteristics of the disease, relapse patterns and the natural history of the rising Prostate Specific Antigen (PSA). Preliminary results suggest that more than 50% of patients who have undergone salvage reirradiation are biochemically relapse-free with very low rates of severe toxicity. Large prospective studies with a longer follow-up are needed to confirm the promising benefit/risk ratio observed with salvage brachytherapy and or salvage nodal radiotherapy and/or SBRT for oligometastatic cases when compared with life-long palliative hormones.
Prostate carcinoma; Locoregional failure; Salvage radiotherapy
Elif Ozkan E, Soyupek S, Erdogan M. Rapid PSA Response of a CRPC after Salvage Irradiation for Locoregional Failure after Radical Local Radiation Therapy: A Case Report. Ann Clin Case Rep. 2019; 4: 1590.