Radiation Therapy After Radical Prostatectomy: What Has Changed Over Time?

Frontiers in Surgery

Derya Tilki¹  Igor Tsaur²  Massimo Valerio³  Roderick van den Bergh⁴  Claudia Kesch⁵  Francesco Ceci⁶  Christian Fankhauser⁷  Giorgio Gandaglia⁸  Alessandro Magli⁹  Alexander Kretschmer^1,10  Isabel Heidegger^1,11  Giancarlo Marra^1,12  Veeru Kasivisvanathan^1,13  Felix Preisser^1,14  Fabio Zattoni^1,17 

[1] 0Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;1Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany;2Department of Urology, CHUV Lausanne, Lausanne, Switzerland;3Department of Urology, Antonius Hospital, Utrecht, Netherlands;4Department of Urology, University Hospital Essen, Essen, Germany;5Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy;6University Hospital Zürich, Zurich, Switzerland;7Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy;Department of Radiation Oncology, Udine General Hospital, Udine, Italy;Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany;Department of Urology, Medical University Innsbruck, Innsbruck, Austria;Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy;Department of Urology, University College London Hospital, London, United Kingdom;Department of Urology, University Hospital Frankfurt, Frankfurt, Germany;Division of Surgery and Interventional Science, University College London, London, United Kingdom;Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf,Hamburg, Germany;Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy;

关键词: prostate cancer;    adjuvant radiotherapy;    salvage radiotherapy;    biochemical recurrence;    hormonal therapy;    genomic classifiers;   

DOI  :  10.3389/fsurg.2021.691473

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown