Local salvage of radiorecurrent prostate cancer

Abstract

AbstractBackgroundLocally recurrent prostate cancer following primary external beam radiotherapy without distant metastasis is a challenging problem, with no current consensus on the optimal management of these patients. Traditional whole‐gland salvage treatments offered up to a 50% 5‐year disease‐free survival rate but with troubling levels of risk for significant complications. Recent progress in advanced imaging techniques has allowed a more accurate selection of patients with local‐only recurrence and a selection of patients that may be suitable for newer partial‐gland salvage treatments that may reduce late complications.MethodsThis article reviews advances in patient selection and provides an overview of whole‐ and partial‐gland salvage results from selected recent meta‐analyses, multi‐institutional series, and studies from centers of excellence for these treatment approaches.ResultsSalvage radical prostatectomy produces 5‐year relapse‐free survival (RFS) rates in the 50%–60% range with severe gastrointestinal (GI) toxicity in < 2% but severe genitourinary (GU) toxicity in 15%–23% of patients. The whole‐gland options of high and low dose rate brachytherapy and stereotactic body radiation therapy appear to offer similar 5‐year control rates, with low severe GU and GI toxicity rates of 4%–8% and <2%, respectively. Cryotherapy and high‐intensity focused ultrasound (HIFU) offer similar 5‐year RFS rates but carry significant risks for severe GU and GI toxicity in the range of 10%–27% and <2%, respectively. Early results of partial‐gland salvage techniques in selected patients appear promising, with 3‐year RFS rates of 48%–72% and rare grade 3 toxicity.ConclusionIt is important to understand the relative effectiveness and risks of the various treatment options to effectively counsel patients who face this distressing clinical situation. Whole‐gland salvage options offer the possibility of long‐term control but with significant risks of severe toxicity. Emerging data for the partial‐gland salvage options in appropriately selected patients may offer hope of reasonable control rates with reduced severe toxicity.