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Clinical

Local salvage therapies in patients with radio-recurrent prostate cancer following external beam radiotherapy: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Introduction

To date, radio-recurrent prostate cancer (PCa) ranks as the fourth most common urological malignancy when considering the number of men with localized PCa who undergo radiation treatment and subsequently experience a biochemical recurrence. This systematic review aimed to summarize available evidence about the outcomes of local salvage strategies in patients with local PCa recurrence following primary external-beam radiation therapy (EBRT).

Methods

We conducted a comprehensive bibliographic search on MEDLINE, Scopus, and Web of Science Core Collection databases in October 2023 to identify studies published in the last 20 years evaluating outcomes of local salvage procedures in patients with locally radio-recurrent PCa following EBRT. The meta-analysis was performed using ProMeta 3 software when two or more studies reported the same outcome. The effect size (ES) was estimated using rates reported with its 95% confidence interval (CI).

Results

Overall, 28 studies (6 prospective and 22 retrospective) including 1544 patients were included in the review. Two-year recurrence-free survival (RFS) was 84.0% (95% CI: 67.0–93.0%), 69.0% (95% CI: 42.0–87.0%), 58.0% (95% CI: 43.0–71.0%), and 45% (95% CI: 38.0–52.0%), for patients undergoing brachytherapy (BT), EBRT, Cryotherapy and High-Intensity Focused Ultrasound (HIFU), respectively. After salvage prostatectomy, RFS ranged from 75% to 78.5% at a median follow-up ranging from 18 to 35 months. Estimates for severe gastrointestinal toxicity were 2%, 3%, 3%, 4%, and 11% following cryotherapy, BT, HIFU, EBRT, and salvage radical prostatectomy, respectively.

Conclusions

In patients who underwent EBRT as primary treatment, prostate salvage re-irradiation through BT or EBRT represents the modality providing the best balance between efficacy and safety. Unfortunately, due to the low level of evidence, strong recommendations regarding the choice of any of these techniques cannot be made.

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Fig. 1
Fig. 2: Forest plot showing pooled estimates for 2-year RFS estimates for various treatment modalities.
Fig. 3: Forest plot showing pooled estimates for 5-year RFS estimates for various treatment modalities.
Fig. 4: Forest plot showing pooled estimates for severe GI toxicity estimates for various treatment modalities.
Fig. 5: Forest plot showing pooled estimates for severe GU toxicity estimates for various treatment modalities.

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Authors and Affiliations

  1. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy

    Massimiliano Creta, Simone Morra & Nicola Longo

  2. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  3. Department of Urology, San Giovanni Battista Hospital, University of Torino, Torino, Italy

    Giancarlo Marra

  4. Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy

    Paolo Gontero

  5. Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy

    Marta Rossanese

  6. S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China

    Jeremy Teoh

  7. Department of Radiation Oncology, University of California, Los Angeles, CA, USA

    Amar U. Kishan

  8. Department of Urology, Mayo Clinic, Rochester, MN, USA

    R. Jeffrey Karnes

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Contributions

Conceptualization, MC, GM; methodology, MC, SFS and GM; software, MC, SM; validation, PG, MR; formal analysis, MC, SM; investigation, JT, AUK; data curation, MC, SM; writing—original draft preparation, MC; writing—review and editing, MC, SM; visualization, RJK, NL; supervision, NL; project administration, SFS. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Simone Morra.

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Creta, M., Shariat, S.F., Marra, G. et al. Local salvage therapies in patients with radio-recurrent prostate cancer following external beam radiotherapy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00883-3

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