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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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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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Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review. World J Urol 2019; 37:1517-1534. [DOI: 10.1007/s00345-019-02642-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022] Open
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Garnon J, Cazzato RL, Koch G, Uri IF, Tsoumakidou G, Caudrelier J, Tricard T, Gangi A, Lang H. Trans-rectal Ultrasound-Guided Autologous Blood Injection in the Interprostatorectal Space Prior to Percutaneous MRI-Guided Cryoablation of the Prostate. Cardiovasc Intervent Radiol 2017; 41:653-659. [PMID: 29230498 DOI: 10.1007/s00270-017-1853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a novel technique of ultrasound-guided injection of autologous blood in the interprostatorectal space, in an attempt to facilitate ablative prostatic procedures by widening durably the space between the rectum and the prostate. MATERIALS AND METHODS Between April and November 2016, four consecutive patients underwent the haemoprotection injection technique. For each patient, we recorded the time to perform the technique, the amount of injected blood, the achieved distances between the rectum and the prostate post-injection at fixed defined points (apex, middle, and base of prostate at the midline, left, and right sides of the gland), the extension of the ice ball outside the prostate capsule at those fixed points, and whether any residual blood was present on 1-month follow-up MRI. RESULTS Mean time to perform haemoprotection injection was 54 min, with an average blood volume of 103 cc. Mean distance achieved at the apex, middle, and base of the prostate, respectively, was 12, 13, and 16 mm in the midline; 8, 10, and 13 mm on the left side; and 9, 10, and 13 mm on the right side. The mean extension distance of the ice ball beyond the capsule was 4, 6, and 6 mm in the midline; 4, 5, and 6 mm on the left side; and 1, 3, and 3 mm on the right side. No residual blood was present on 1-month follow-up MRI in all patients. No rectal fistula occurred. CONCLUSION Haemoprotection may create a safe and effective virtual space between the prostate and rectum.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Ishaq Fahmi Uri
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
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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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Abstract
Cryosurgery, a method of treating disease by the production of freezing temperatures in the tissue, is a useful technique for the treatment of tumors. When the modern era of cryosurgery began in the mid 1960's, the technique was used only for tumors easily accessible by direct observation or via endoscopy, such as those of the skin, oral cavity, and prostate gland. In general, the technique had limited usefulness in the next two decades. However, with the advent of intraoperative ultrasound as a method of monitoring the process of freezing and with the development of more effective cryosurgical apparatus, the cryosurgical treatment of tumors of the viscera and other deep tissues became practical in the 1990's. This review assesses the present day status of cryosurgery in the management of diverse tumors.
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Affiliation(s)
- Andrew A Gage
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 14214, USA.
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Griffin RJ, Williams BW, Roberts KP, Swanlund DJ, Bischof JC. Assessing pH and Oxygenation in Cryotherapy-induced Cytotoxicity and Tissue Response to Freezing. Technol Cancer Res Treat 2016; 3:245-51. [PMID: 15161317 DOI: 10.1177/153303460400300302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The microenvironmental pH and oxygenation is known to influence tumor cell response to heat, radiation, photodynamic and even chemotherapy. We have studied the previously untested influence of acidity and hypoxia on tumor and endothelial cell sensitivity to freezing. In addition, we have measured changes in oxygenation in vivo in murine FSaII fibrosarcomas after freeze injury. A low pH or low oxygenation environment was found to increase the sensitivity of tumor and endothelial cells to freezing at −20° C or −40° C in vitro. However, low pH and low oxygenation combined did not further increase cryosensitivity of the cells. In vivo, tumor oxygenation after freeze injury was studied immediately or 1–3 days after a standard freezing protocol was applied to FSaII tumors ranging from 250–500 mm3 grown in the rear-limb of C3H mice. Tumor oxygenation at the edge of the iceball was found to transiently increase 1–2 hours after freezing. At 1–3 days after freezing, a treatment that delayed FSaII tumor growth by approximately 1.5-fold, the mean tumor oxygenation was significantly increased by up to 2.5-fold from a control level of 5 mmHg partial pressure of oxygen (pO2), especially at the periphery of the tumor. We conclude that manipulation of pH or oxygenation has potential to increase the anti-tumor effects of minimally invasive cryosurgical techniques. Furthermore, the dynamic changes in oxygenation after freeze injury in vivo suggests value in combining cryotherapy with treatments dependent on oxygenation levels. Ultimately, these may be routes to more reliable treatment response with fewer recurrences.
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Affiliation(s)
- Robert J Griffin
- University of Minnesota, Department of Therapeutic Radiology, 420 Delaware St. SE, MMC 494, Minneapolis, MN 55455, USA.
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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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13
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Choi M, Kim CR, Hung AY. Salvage Intensity-Modulated Radiation Therapy for Locally Recurrent Prostate Cancer After Cryotherapy. Clin Genitourin Cancer 2013; 11:85-8. [DOI: 10.1016/j.clgc.2012.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/30/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022]
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Pisters LL. Editorial Comment. Urology 2008. [DOI: 10.1016/j.urology.2008.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Hepel JT, MacAusland SG, Long JP, Wazer DE, DiPetrillo T. Intensity-Modulated Radiotherapy of the Prostate After Cryotherapy: Initial Experience. Urology 2008; 72:1310-4; discussion 1314. [DOI: 10.1016/j.urology.2008.01.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 01/21/2008] [Accepted: 01/24/2008] [Indexed: 12/01/2022]
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Salvage Radiotherapy for Local Relapse after Primary Cryotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2008; 20:567-8. [DOI: 10.1016/j.clon.2008.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 05/21/2008] [Indexed: 11/24/2022]
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Wirth MP, Engelhardt FM. [PSA recurrence after primary curative therapy--local or systemic? When is a second curative therapy still possible?]. Urologe A 2005; 44:997-1004, 1006-7. [PMID: 16133232 DOI: 10.1007/s00120-005-0879-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PSA recurrence after primary curative therapy for localized prostate cancer is a common problem. Further curative treatment is only reasonable in the case of local recurrence. Therefore, minimizing the likelihood of metastatic disease is crucial. So far, imaging techniques cannot distinguish between local recurrence and distant metastasis. It is therefore reasonable to orientate on PSA kinetics and pathological criteria. Histologic confirmation of suspected local recurrence after radical prostatectomy before salvage therapy is not required. However, after initial radiation therapy histologic confirmation of suspected isolated local recurrence should be obtained. The optimal treatment for a PSA recurrence depends on the initial therapy and the life-expectancy of the patient.
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Affiliation(s)
- M P Wirth
- Klinik und Poliklinik für Urologie am Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden
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