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Takemura LS, Costa PHP, Claros OR, Tourinho-Barbosa RR, Teles SB, Sanchez-Salas R, Nahar B, Olivares R, Montagna E, Lemos GC, Bianco B, Carneiro A. Salvage local treatment for recurrent prostate cancer after focal therapy: A systematic review and meta-analysis. Urol Oncol 2024:S1078-1439(24)00630-6. [PMID: 39256147 DOI: 10.1016/j.urolonc.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/29/2024] [Accepted: 08/16/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES To evaluate the role of salvage local treatment in managing recurrent PCa following FT, focusing on oncological and functional outcomes. METHODS A systematic review and meta-analysis were performed following the PRISMA framework. A comprehensive literature search using the PubMed/MEDLINE and EMBASE databases was performed until July 2023. Eligible studies included patients with clinically localised PCa initially treated with FT, who experienced relapse during surveillance and subsequently underwent salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT) or salvage focal therapy (sFT). The primary endpoint was the biochemical recurrence rate post-salvage treatment. The secondary endpoints were functional outcomes, including urinary incontinence and erectile dysfunction rates. RESULTS In 26 retrospective studies including 990 patients, the overall pooled biochemical recurrence rate postsalvage treatment was 26%. The subgroup analysis revealed a biochemical recurrence rate of 20%, 22%, and 42% after sRP, sEBRT, and sFT, respectively. The overall pooled rate of urinary incontinence was 20%. Salvage FT had the lowest prevalence of urinary incontinence, followed by sRP and sEBRT. The overall pooled rate of erectile dysfunction was 43%. Salvage RP had the highest prevalence of erectile dysfunction, followed by sFT and sEBRT. Substantial heterogeneity was observed among the studies, primarily due to different sample sizes. Meta-regression analysis revealed no to low contributions of salvage treatment modalities, extent of ablation, age, prostatic specific antigen level before salvage treatment, proportion of patients with Gleason score ≥7 at recurrence, and time between the primary and salvage therapies to heterogeneity. CONCLUSION Salvage local treatment for recurrent PCa after FT is feasible, and it provides acceptable oncological and functional outcomes. Among all treatment modalities, sRP and sEBRT appeared to have the lowest biochemical recurrence rates, whereas sFT was associated with improved functional outcomes.
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Affiliation(s)
| | | | - Oliver Rojas Claros
- Hospital Israelita Albert Einstein, Department of Urology, São Paulo, São Paulo
| | | | | | | | - Bruno Nahar
- University of Miami Miller School of Medicine, Department of Urology, Miami, FL
| | - Ruben Olivares
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Erik Montagna
- Faculdade de Medicina do ABC/Centro Universitário FMABC, Santo André, São Paulo
| | | | - Bianca Bianco
- Hospital Israelita Albert Einstein, Department of Urology, São Paulo, São Paulo
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Department of Urology, São Paulo, São Paulo.
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Perennec T, Rogé M, Hetet JF, Colls P, Guimas V, Rio E, Vaugier L, Supiot S. Salvage prostate intensity modulated radiation therapy after cryotherapy failure. Sci Rep 2024; 14:9148. [PMID: 38644367 PMCID: PMC11033268 DOI: 10.1038/s41598-024-59406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Cryotherapy is an ablative therapy that can be used to treat localized prostate cancer. In case of recurrence, treatment options are not well-defined, and their outcomes are unknown. We therefore collected all patients treated with radiotherapy after cryotherapy for prostate cancer recurrence in Nantes (France) between 2012 and 2019. We identified ten patients. After a median follow-up of 5 years, two patients presented late grade 3 toxicities; one patient presented a grade 3 rectal hemorrhage, and one had a grade 3 hematuria. Two patients relapsed at 61 and 62 months, and three patients died of other causes. Radiotherapy to treat local prostate cancer recurrence after cryotherapy seems feasible and effective in local control. These results do not allow us to recommend this technique in current practice but are encouraging for the conduct of prospective trials.
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Affiliation(s)
- Tanguy Perennec
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France.
| | - Maximilien Rogé
- Department of Radiation Oncology, Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Jean-François Hetet
- Department of Urology, Clinique Jules Verne, 2-4 Route de Paris, 44300, Nantes, France
| | - Philippe Colls
- Department of Urology, Clinique Jules Verne, 2-4 Route de Paris, 44300, Nantes, France
| | - Valentine Guimas
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Loïg Vaugier
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
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Rogé M, Perennec T, Guimas V, Hetet JF, Rio E, Vaugier L, Supiot S. Salvage radiotherapy after initial cryotherapy for localized prostate cancer: A systematic review of the literature. Crit Rev Oncol Hematol 2023; 192:104149. [PMID: 37813320 DOI: 10.1016/j.critrevonc.2023.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/31/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
The treatment of local prostate cancer recurrence after cryotherapy is challenging since the optimal management is unknown. We collected the available evidence to date to better define the risk and benefit of salvage radiotherapy (SRT) after cryotherapy failure for localized prostate cancer. This review confirms the feasibility of SRT in terms of biochemical control and late toxicity rate. However, the absence of comparative trials or prospective studies, coupled with the heterogeneity of patients treated and the variations in treatments delivered across the analyzed studies, highlights the need for cautious consideration when opting for salvage radiotherapy. Therefore, we highly recommend the inclusion of patients in dedicated clinical trials to comprehensively assess the efficacy and safety of this approach.
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Affiliation(s)
- Maximilien Rogé
- Department of radiation oncology, Centre Henri Becquerel, 1 rue d'Amiens, 76000, Rouen, France.
| | - Tanguy Perennec
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Valentine Guimas
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Jean-François Hetet
- Department of Urology, Clinique Jules Verne, 2-4 route de Paris, 44300, Nantes, France
| | - Emmanuel Rio
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Loïg Vaugier
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
| | - Stéphane Supiot
- Department of radiation oncology, Institut de Cancérologie de l'Ouest, Bd Professeur Jacques Monod, 44800 Saint-Herblain, France
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Deivasigamani S, Orabi H, El-Shafei A, Adams ES, Kotamarti S, Aminsharifi A, Davis L, Wu Y, J SJ, Polascik TJ. Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis. Prostate 2023; 83:1373-1386. [PMID: 37469120 DOI: 10.1002/pros.24600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT). METHODS An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW. RESULTS A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different. CONCLUSION CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.
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Affiliation(s)
- Sriram Deivasigamani
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Hazem Orabi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed El-Shafei
- Department of Urology, University of Florida Health, Jacksonville, Florida, USA
| | - Eric S Adams
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Srinath Kotamarti
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ali Aminsharifi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Leah Davis
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuan Wu
- Duke Cancer Institute and Department of Statistics, Durham, North Carolina, USA
| | | | - Thomas J Polascik
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
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Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation. Adv Radiat Oncol 2022; 7:100849. [PMID: 35647408 PMCID: PMC9133399 DOI: 10.1016/j.adro.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
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Jiang C, Godette K, Hall WA, Bennett JK, Rossi P, Cooper S, Jani AB, Patel PR. Early Comparative Toxicity Outcomes of Patients With Prostate Cancer Receiving Initial Cryotherapy and Radiotherapy Salvage. Clin Genitourin Cancer 2020; 19:267-270.e1. [PMID: 33191148 DOI: 10.1016/j.clgc.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Karen Godette
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Wauwatosa, WI
| | | | - Peter Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sherrie Cooper
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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7
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Salvage Local Treatments After Focal Therapy for Prostate Cancer. Eur Urol Oncol 2019; 2:526-538. [DOI: 10.1016/j.euo.2019.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
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Hopper AB, Sandhu APS, Parsons JK, Rose B, Einck JP. Salvage image guided radiation therapy to the prostate after cryotherapy failure. Adv Radiat Oncol 2017; 3:52-56. [PMID: 29556580 PMCID: PMC5856984 DOI: 10.1016/j.adro.2017.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose Cryotherapy is an option for the primary treatment of localized prostate cancer, along with radical prostatectomy, external beam radiation therapy, and brachytherapy. Although it is known that local recurrence can occur in >20% of patients treated with primary cryotherapy, unfortunately there is a paucity of data on later salvage treatments. The use of external beam radiation therapy is an attractive option after cryotherapy failure, but there is little data on its efficacy and toxicity. We evaluated the biochemical control and complication rates of salvage dose-escalated image guided intensity modulated radiation therapy (IG-IMRT) after cryotherapy failure. Methods and materials Patients who were treated at our institution from 2005 to 2016 were reviewed for those who underwent cryotherapy as initial treatment followed by salvage IGRT. Patients were treated with dose-escalated IG-IMRT using standard treatment margins of 3 mm posterior and 7 mm in all other directions and daily cone beam computed tomography or kv imaging to implanted fiducial markers. Biochemical progression was defined in accordance with the Phoenix consensus conference definition. Results Eight patients were identified as having received post-cryotherapy salvage radiation within the study period. The median total dose was 77.7 Gy (range, 75.6-81.0 Gy). Median follow-up was 55 months (range, 6-88 months). Six patients remained biochemically controlled at the latest follow-up. One patient developed distant metastases after 22 months and one experienced biochemical failure at 30 months with no evidence of distant metastases. No patients experienced acute gastrointestinal toxicities of grade 2 or higher. There were no cases of late gastrointestinal or genitourinary toxicity. Conclusions High-dose IG-IMRT results in high rates of salvage and extremely low rates of serious late toxicity for patients with locally recurrent prostate cancer after cryotherapy. Although the results are encouraging, given the small number of patients in this and other series, we remain cautious with regard to this treatment and believe the use of salvage radiation therapy after cryotherapy warrants further study.
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Affiliation(s)
- Austin B Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Ajay P S Sandhu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - J Kellogg Parsons
- Department of Urology, University of California San Diego, La Jolla, California
| | - Brent Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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Barret E, Sanchez-Salas R, Galiano M, Cathala N, Mombet A, Prapotnich D, Rozet F, Gangi A, Lang H, Cathelineau X. [Management of ablative therapies in prostate cancer]. Prog Urol 2017; 27:909-925. [PMID: 28918872 DOI: 10.1016/j.purol.2017.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the specific modalities of ablative therapies management in prostate cancer. MATERIALS AND METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 61 articles were analysed. RESULTS Development of innovations such as ablative therapies in prostate cancer induces specific modalities in their management, during pre-, per- and post-procedure. More than for classical and well-known treatments, the decision to propose an ablative therapy requires analysis and consensus of medical staff and patient's agreement. Patient's specificities and economical aspects must also be considered. Procedures and follow-up must be realized by referents actors. CONCLUSION Indication, procedure and follow-up of ablative therapies in prostate cancer require specific modalities. They must be respected in order to optimize the results and to obtain a precise and objective evaluation for defining future indications.
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Affiliation(s)
- E Barret
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - M Galiano
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - N Cathala
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Mombet
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - D Prapotnich
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Rozet
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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Holtzman AL, Hoppe BS, Letter HP, Bryant C, Nichols RC, Henderson RH, Mendenhall WM, Morris CG, Williams CR, Li Z, Mendenhall NP. Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound. Int J Radiat Oncol Biol Phys 2016; 95:465-471. [DOI: 10.1016/j.ijrobp.2015.12.351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
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