Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure : A systematic review of the literature
✍ Scribed by Paul L. Nguyen; Anthony V. D'Amico; Andrew K. Lee; W. Warren Suh
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 137 KB
- Volume
- 110
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Abstract
Among men who experience prostate‐specific antigen (PSA) failure after external beam radiation or brachytherapy (RT), many will harbor occult micrometastases; however, a significant minority will have a true local‐only failure and, thus, potentially may benefit from a salvage local therapy. Those most likely to have a local‐only failure initially have low‐risk disease (PSA < 10 ng/mL, Gleason score ≤6, clinical T1c or T2a tumor status), pretreatment PSA velocity < 2.0 ng/mL per year at the time of initial presentation, interval to PSA failure > 3 years, PSA doubling time > 12 months, negative bone scan and pelvic imaging, and positive rebiopsy. In addition, men with presalvage PSA levels > 10 ng/mL, presalvage T3/T4 disease, or presalvage Gleason scores ≥7 on a rebiopsy sample without significant RT effects are unlikely to be cured by salvage local therapy. Based on a review of all series of post‐RT salvage prostatectomy, cryosurgery, and brachytherapy published in English since 1990, morbidity can be substantial. Although urinary incontinence appeared to be greater after salvage prostatectomy (41%) or cryosurgery (36%) than after brachytherapy (6%), patients who received salvage brachytherapy faced a 17% risk of grade 3 or 4 genitourinary complications and a fistula risk that averaged 3.4% across all series. From this review, the authors concluded that prospective randomized studies are needed to determine the relative efficacy of the 3 major local salvage modalities and that additional research is needed to identify factors associated with an increased risk of significant complications to improve patient selection and to augment the benefit/risk ratio associated with attempts to cure local‐only recurrences after radiation therapy. Cancer 2007. © 2007 American Cancer Society.